Provider Demographics
NPI:1508040098
Name:SORRELLS, JOHN T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:SORRELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7330 SAN PEDRO
Mailing Address - Street 2:STE. 405
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6235
Mailing Address - Country:US
Mailing Address - Phone:210-344-2673
Mailing Address - Fax:210-344-2649
Practice Address - Street 1:7330 SAN PEDRO
Practice Address - Street 2:STE. 405
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6235
Practice Address - Country:US
Practice Address - Phone:210-344-2673
Practice Address - Fax:210-344-2649
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM9021207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6902Medicare PIN