Healthcare Provider Details

I. General information

NPI: 1639172786
Provider Name (Legal Business Name): MARK H. SORIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 82ND ST STE F
LUBBOCK TX
79423-2065
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-722-7400
  • Fax: 806-722-7404
Mailing address:
  • Phone: 806-785-2045
  • Fax: 806-722-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ9818
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: