Healthcare Provider Details

I. General information

NPI: 1568810323
Provider Name (Legal Business Name): MICHAEL ANTHONY SORTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3593 E GRANDE BLVD
TYLER TX
75707-1400
US

IV. Provider business mailing address

PO BOX 846098
DALLAS TX
75284-0001
US

V. Phone/Fax

Practice location:
  • Phone: 903-839-2585
  • Fax:
Mailing address:
  • Phone: 903-324-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11546
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS8253
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: