Provider Demographics
NPI:1518961119
Name:SORNSON, ELMER THEODORE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELMER
Middle Name:THEODORE
Last Name:SORNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:655 MEDICAL CENTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2751
Mailing Address - Country:US
Mailing Address - Phone:503-581-5287
Mailing Address - Fax:503-588-6843
Practice Address - Street 1:655 MEDICAL CENTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2751
Practice Address - Country:US
Practice Address - Phone:503-581-5287
Practice Address - Fax:503-588-6843
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD06798207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR17451-6Medicaid
C93819Medicare UPIN
OR17451-6Medicaid
OR0749740001Medicare NSC