Provider Demographics
NPI:1164490280
Name:SORENSEN, SHERMAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERMAN
Middle Name:G
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5169 S COTTONWOOD ST
Mailing Address - Street 2:610
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-507-3656
Mailing Address - Fax:801-507-3657
Practice Address - Street 1:5169 S COTTONWOOD ST
Practice Address - Street 2:610
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-507-3656
Practice Address - Fax:801-507-3657
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT168722-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC63528Medicare UPIN