Provider Demographics
NPI:1609839653
Name:SORRELS, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:SORRELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-623-2781
Mailing Address - Fax:501-623-1774
Practice Address - Street 1:1662 HIGDON FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6912
Practice Address - Country:US
Practice Address - Phone:501-623-2781
Practice Address - Fax:501-623-1774
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105028001Medicaid
AR110143981Medicare PIN
AR550097343Medicare PIN
ARB90583Medicare UPIN
AR550097470Medicare PIN
AR55009F484Medicare PIN