Healthcare Provider Details

I. General information

NPI: 1831107432
Provider Name (Legal Business Name): ARIADNA L BORY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BILL OWENS PKWY
LONGVIEW TX
75604-6210
US

IV. Provider business mailing address

2 STONERIDGE TRL
LONGVIEW TX
75605-2725
US

V. Phone/Fax

Practice location:
  • Phone: 903-247-3400
  • Fax: 903-238-9183
Mailing address:
  • Phone: 305-331-4500
  • Fax: 903-238-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM3922
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: