Provider Demographics
NPI:1811937212
Name:SORENSEN, ELIZABETH ANNE (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 SHOAL CREEK BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7526
Mailing Address - Country:US
Mailing Address - Phone:512-522-7520
Mailing Address - Fax:512-298-0795
Practice Address - Street 1:3921 STECK AVE
Practice Address - Street 2:STE A110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8647
Practice Address - Country:US
Practice Address - Phone:512-522-7520
Practice Address - Fax:512-298-0795
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01682207Q00000X
TXP1412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2005-01682OtherMEDICAL LICENSE
NC5904722Medicaid
NC2005-01682OtherMEDICAL LICENSE