Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 04-44741 | KS |
N | 207QS0010X | Family Doctor - Sports Medicine | 04-44741 | KS |
NPI | 1083143002 |
---|---|
Provider Name | Ryan Christopher Sorell |
First Address | Joplin, MO 64803-3810 |
Second Address | Pittsburg, KS 66762-6623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2017 |
Last Update Date | 08/11/2021 |