Provider Demographics
NPI:1508191743
Name:SOROKIN, ALEXEY VASILIEVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXEY
Middle Name:VASILIEVICH
Last Name:SOROKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEXEY
Other - Middle Name:VASILIEVICH
Other - Last Name:SOROKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 UNSER BLVD. S.E.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-248-1800
Mailing Address - Fax:505-248-1917
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:505-248-1800
Practice Address - Fax:505-248-1917
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043726207R00000X
NMMD2009-0792207RC0000X
FLME117777207R00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03727823Medicaid
NM03727823Medicaid