Provider Demographics
NPI:1437189156
Name:SORIAL, REDA FAWZI (MD)
Entity Type:Individual
Prefix:DR
First Name:REDA
Middle Name:FAWZI
Last Name:SORIAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:601 E SAMPLE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4443
Practice Address - Country:US
Practice Address - Phone:954-785-0525
Practice Address - Fax:954-943-1455
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME40821208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0748993OtherCIGNA
FL1193473OtherWELLCARE
FLP0003171OtherFLORIDA HEALTHCARE PLUS
FL047343000Medicaid
FLQMP000003722540OtherMOLINA HEALTH
FL4008211OtherAETNA
FL94305OtherBC/BS
FLP00900590OtherRAILROAD MCR
FLD27789Medicare UPIN
FLP0003171OtherFLORIDA HEALTHCARE PLUS
FL047343000Medicaid