Individual
DR. GLEN W SORRENTINO
Active
Individual
DR. GLEN W SORRENTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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