Provider Demographics
NPI:1710972740
Name:SORENSEN, RONALD S (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 E MAIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3198
Mailing Address - Country:US
Mailing Address - Phone:253-841-2006
Mailing Address - Fax:253-840-6691
Practice Address - Street 1:2728 E MAIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3198
Practice Address - Country:US
Practice Address - Phone:253-848-0131
Practice Address - Fax:253-840-6787
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000510213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASO1011OtherREGENCE
WA8148843Medicaid
WACJ4574OtherRAIL ROAD MEDICARE
WA0155721OtherLABOR AND INDUSTRIES
WAG8906852Medicare PIN
WAU42915Medicare UPIN
WAAB25245Medicare ID - Type UnspecifiedKING COUNTY NUMBER
WACJ4574OtherRAIL ROAD MEDICARE
WASO1011OtherREGENCE
WA8148843Medicaid