Provider Demographics
NPI:1700156064
Name:MORTENSEN, WILLIAM SOREN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SOREN
Last Name:MORTENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6630 S MCCARRAN BLVD STE A9
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6136
Mailing Address - Country:US
Mailing Address - Phone:775-829-1212
Mailing Address - Fax:775-829-1179
Practice Address - Street 1:6630 S MCCARRAN BLVD STE A9
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6136
Practice Address - Country:US
Practice Address - Phone:775-829-1212
Practice Address - Fax:775-829-1179
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123991207N00000X
NV15717207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology