Provider Demographics
NPI:1245332501
Name:SORENSEN, MARK DANA (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DANA
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HILCREST PLAZA WAY
Mailing Address - Street 2:VA CLINIC
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-249-7791
Mailing Address - Fax:970-240-7808
Practice Address - Street 1:4 HILLCREST PLAZA WAY
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5876
Practice Address - Country:US
Practice Address - Phone:970-249-7791
Practice Address - Fax:970-240-7808
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
CO1302363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical