Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 01061869A | IN |
N | 2081P2900X | Pain Medicine | 01061869A | IN |
NPI | 1093932055 |
---|---|
Provider Name | Jason K Sorg |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46256-1621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000555974 | ANTHEM (01) | IN |
20090050 | (05) | IN |
453271 | WELLCARE (01) | IN |
9705140 | AETNA (01) | IN |
P01292382 | RAILROAD MEDICARE (01) | IN |