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General NPI Number Information
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NPI Number | 1205148376
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Entity Type | Individual
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Provider Name | SOURIAL MORRIS SOURIAL D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 9770 OLD BAYMEADOWS RD STE 141
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7986
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Country | US
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Telephone | 904-944-2124
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Fax | 888-241-3383
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Provider Business Mailing Address
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Address Line | 10689 TOWN VIEW DR
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4026
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Country | US
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Telephone | 917-940-7644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | OS11425
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | OS11425
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | OS11425
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License Number State | FL
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