Individual
ERIC LUTHER SORENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
929 SW SIMPSON AVE STE 300, BEND, OR 97702-3599
(541) 389-7741
(541) 278-8375
Mailing address
929 SW SIMPSON AVE STE 300, BEND, OR 97702-3599
(541) 389-7741
(541) 278-8375
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA190165
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA190165
STATE LICENSE
OR
Enumeration date
04/10/2018
Last updated
10/08/2018
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