Provider Demographics
NPI:1033353099
Name:LIESER, SOFIA ANA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SOFIA
Middle Name:ANA
Last Name:LIESER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W COLLEGE ST STE 540
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3589
Mailing Address - Country:US
Mailing Address - Phone:817-481-5863
Mailing Address - Fax:817-329-8561
Practice Address - Street 1:1600 W COLLEGE ST STE 540
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3589
Practice Address - Country:US
Practice Address - Phone:817-481-5863
Practice Address - Fax:817-329-8561
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35120978207V00000X
TXQ4178207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082670Medicaid
OH1033353099OtherBWC
OHH206560Medicare PIN