Provider Demographics
NPI:1629037486
Name:PETRE, SORIN (MD)
Entity Type:Individual
Prefix:
First Name:SORIN
Middle Name:
Last Name:PETRE
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 1:2801 NW MERCY DR STE 340
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2348
Mailing Address - Country:US
Mailing Address - Phone:541-677-4319
Mailing Address - Fax:541-677-2294
Practice Address - Street 1:2510 NW EDENBOWER BLVD STE 112
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8899
Practice Address - Country:US
Practice Address - Phone:541-464-6260
Practice Address - Fax:541-229-0014
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27632207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500601705Medicaid
ORMD27638OtherMEDICAL LICENSE
ORR175950Medicare PIN