Provider Demographics
NPI:1609304559
Name:SORENSEN, THOMAS CARL (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CARL
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:9040 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8635
Practice Address - Country:US
Practice Address - Phone:509-942-3291
Practice Address - Fax:509-783-6827
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2020-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61086310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine