Provider Demographics
NPI:1952740045
Name:JR SORELLE ARIZONA PC
Entity type:Organization
Organization Name:JR SORELLE ARIZONA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SORELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-739-4263
Mailing Address - Street 1:9080 W POST RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2419
Mailing Address - Country:US
Mailing Address - Phone:702-739-4263
Mailing Address - Fax:877-739-3590
Practice Address - Street 1:5300 S HIGHWAY 95
Practice Address - Street 2:SUITE M
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9251
Practice Address - Country:US
Practice Address - Phone:702-739-4263
Practice Address - Fax:877-739-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ410102086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty