Provider Demographics
NPI:1245283357
Name:SORRESSO, DENNIS PETER (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PETER
Last Name:SORRESSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 SOUTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7014
Mailing Address - Country:US
Mailing Address - Phone:904-465-3183
Mailing Address - Fax:904-264-3761
Practice Address - Street 1:159 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2103
Practice Address - Country:US
Practice Address - Phone:904-465-3183
Practice Address - Fax:904-264-3761
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80561207RP1001X
FLME0080561207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263187300Medicaid
FLH29482Medicare UPIN
FL35557YMedicare PIN
35557ZMedicare ID - Type Unspecified