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General NPI Number Information
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NPI Number | 1356743876
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Entity Type | Organization
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Legal Business Name | SOURIAL MORRIS SOURIAL MD
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 16670 S US HIGHWAY 441 SUITE 103
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8683
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Country | US
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Telephone | 352-347-1608
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Fax | 888-241-3383
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Provider Business Mailing Address
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Address Line | 16670 S US HIGHWAY 441 SUITE 103
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8683
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Country | US
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Telephone | 352-347-1608
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Fax | 888-241-3383
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SOURIAL MORRIS SOURIAL
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Credential | D.O.
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Telephone | 352-347-1608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | OS11425
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License Number State | FL
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