Provider Demographics
NPI:1689860736
Name:SORENSEN, DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:SORENSEN
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 1:250 BOBWHITE CT
Mailing Address - Street 2:275
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6643
Mailing Address - Country:US
Mailing Address - Phone:208-333-0200
Mailing Address - Fax:208-333-0399
Practice Address - Street 1:250 BOBWHITE CT
Practice Address - Street 2:275
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6643
Practice Address - Country:US
Practice Address - Phone:208-333-0200
Practice Address - Fax:208-333-0399
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-2958208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery