Provider Demographics
NPI:1427322585
Name:SORIAL, MARY ELIAS (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIAS
Last Name:SORIAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ELIAS
Other - Last Name:ELIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:734 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-1428
Mailing Address - Country:US
Mailing Address - Phone:903-389-2181
Mailing Address - Fax:903-389-0901
Practice Address - Street 1:734 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:TX
Practice Address - Zip Code:75840-1428
Practice Address - Country:US
Practice Address - Phone:903-389-2181
Practice Address - Fax:903-389-0901
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ3178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program