Provider Demographics
NPI:1124033626
Name:SONNENBERG, AMNON (MD)
Entity Type:Individual
Prefix:
First Name:AMNON
Middle Name:
Last Name:SONNENBERG
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 1:3710 SW US VETERANS HOSPITAL RD
Mailing Address - Street 2:PORTLAND VA MEDICAL CENTER, P3-GI
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2964
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-220-3426
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:PORTLAND VA MEDICAL CENTER, P3-GI
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:503-220-3426
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL16137207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227422Medicaid
OR227422Medicaid