Provider Demographics
NPI:1235220799
Name:SORENSON, ROBERT LYNN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LYNN
Last Name:SORENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3010 COLBY ST
Mailing Address - Street 2:STE 114
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2059
Mailing Address - Country:US
Mailing Address - Phone:510-848-1413
Mailing Address - Fax:510-848-7347
Practice Address - Street 1:3010 COLBY ST
Practice Address - Street 2:STE 114
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2059
Practice Address - Country:US
Practice Address - Phone:510-848-1413
Practice Address - Fax:510-848-7347
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG045092207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0021950Medicaid
CAG045092OtherSTATE LICENSE
CAA49882Medicare UPIN
CAG045092OtherSTATE LICENSE
CAGR0021950Medicaid