Individual
DR. GLEN W SORRENTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 EAST DOUGLAS, TYLER, TX 75702
(903) 593-1721
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3092
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178726902
—
TX
01
—
750818167015
TRICARE
TX
01
—
750818167022
TRICARE
TX
01
—
750818167044
TRICARE
TX
01
—
750818167048
TRICARE
TX
01
—
751976930005
TRICARE
TX
Enumeration date
02/21/2006
Last updated
10/14/2014
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