Provider Demographics
NPI:1669412573
Name:SORENSON, CHARLES L (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:SORENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12 NW VALLEY RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9531
Mailing Address - Country:US
Mailing Address - Phone:580-536-6353
Mailing Address - Fax:580-536-6873
Practice Address - Street 1:12 NW VALLEY RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9531
Practice Address - Country:US
Practice Address - Phone:580-536-6353
Practice Address - Fax:580-536-6873
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK16221146D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant