Provider Demographics
NPI:1154307833
Name:SORIN, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SORIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:SORIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:900 E 30TH ST
Mailing Address - Street 2:#107
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3326
Mailing Address - Country:US
Mailing Address - Phone:512-452-1521
Mailing Address - Fax:512-302-3940
Practice Address - Street 1:900 E 30TH ST
Practice Address - Street 2:#107
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3326
Practice Address - Country:US
Practice Address - Phone:512-452-1521
Practice Address - Fax:512-302-3940
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7347207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139202904Medicaid
742384629OtherTAX ID
TX139202904Medicaid