Provider Demographics
NPI:1669448346
Name:SORENSEN, DOUGLAS MELVILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MELVILLE
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DOUGLAS
Other - Middle Name:MELVILLE
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1608 S J ST FL 5
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-426-6731
Mailing Address - Fax:
Practice Address - Street 1:1608 S J ST FL 5
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-426-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038718207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003402Medicaid