1639195704 NPI number — DR. MATTHEW D SORENSEN MD

Table of content: DR. MATTHEW D SORENSEN MD (NPI 1639195704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639195704 NPI number — DR. MATTHEW D SORENSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORENSEN
Provider First Name:
MATTHEW
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639195704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 E HARMONY RD
Provider Second Line Business Mailing Address:
SUITE 170
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80528-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-495-7421
Provider Business Mailing Address Fax Number:
970-493-3528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 E HARMONY RD
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80528-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-495-7421
Provider Business Practice Location Address Fax Number:
970-493-3528
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  DR.0045362 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 125242900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00476434 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 93479000 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com