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General NPI Number Information
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NPI Number | 1568810323
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY SORTO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 3593 E GRANDE BLVD
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City | TYLER
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State | TX
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Zip | 75707-1400
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Country | US
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Telephone | 903-839-2585
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846098
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City | DALLAS
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State | TX
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Zip | 75284-0001
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Country | US
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Telephone | 903-324-6400
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 11546
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License Number State | ZZ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | S8253
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License Number State | TX
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