Provider Demographics
NPI:1104016278
Name:SOKALSKI, DOMINIK GRZEGORZ (MD)
Entity type:Individual
Prefix:
First Name:DOMINIK
Middle Name:GRZEGORZ
Last Name:SOKALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5207
Mailing Address - Country:US
Mailing Address - Phone:541-773-4291
Mailing Address - Fax:541-773-4291
Practice Address - Street 1:1365 POPLAR DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5207
Practice Address - Country:US
Practice Address - Phone:541-773-2233
Practice Address - Fax:541-773-7089
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD153128207RR0500X
CO56254207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR194430OtherMEDICARE OR
OR500722930Medicaid
ORMD153128OtherSTATE LICENSE
CO478052ZL1POtherMEDICARE CO
CODR.0056254OtherSTATE LICENSE