| Doctor Name: | DR. JEFFREY A SORENSEN |
| NPI Number: | 1578805651 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 28130 |
| Business Practice Address: | 3278 Mitchell Blvd Bldg 900 Moody Afb, GA - 316991500 |
| Business Phone Number: | 2292582815 |
| Business Fax Number: | |
| Mailing Address: | 3278 Mitchell Blvd Bldg 900, MOODY AFB |
| State: | GA |
| Postal Code: | 316991500 |
| Phone Number: | 2292582815 |
| Fax Number: | |
| NPI Enumeration Date: | 03/26/2013 |
| NPI Last Update Date: | 10/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 28130 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |