Provider Demographics
NPI:1386967404
Name:DR. SOROKOLIT, M.D., P.A
Entity type:Organization
Organization Name:DR. SOROKOLIT, M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:T
Authorized Official - Last Name:SOROKOLIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-332-9359
Mailing Address - Street 1:909 9TH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3903
Mailing Address - Country:US
Mailing Address - Phone:817-332-9359
Mailing Address - Fax:817-332-8030
Practice Address - Street 1:909 9TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3903
Practice Address - Country:US
Practice Address - Phone:817-332-9359
Practice Address - Fax:817-332-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB26574OtherUPIN
TX110112303Medicaid
TX00TF45Medicare PIN