Provider Demographics
NPI:1669629853
Name:JON SORELLE SURGICAL, P.C.
Entity Type:Organization
Organization Name:JON SORELLE SURGICAL, P.C.
Other - Org Name:BROWN HAND CENTER, LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MEDICAL CREDENTIALS
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMC
Authorized Official - Phone:713-586-6705
Mailing Address - Street 1:4131 DIRECTORS ROW
Mailing Address - Street 2:PO BOX 924587
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8703
Mailing Address - Country:US
Mailing Address - Phone:713-586-6705
Mailing Address - Fax:713-586-6752
Practice Address - Street 1:880 SEVEN HILLS DR
Practice Address - Street 2:SUITE 140
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4371
Practice Address - Country:US
Practice Address - Phone:702-889-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV125622086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty