Provider Demographics
NPI:1831107432
Name:BORY, ARIADNA L (DO)
Entity Type:Individual
Prefix:DR
First Name:ARIADNA
Middle Name:L
Last Name:BORY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STONERIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2725
Mailing Address - Country:US
Mailing Address - Phone:305-331-4500
Mailing Address - Fax:903-238-9183
Practice Address - Street 1:2010 BILL OWENS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6210
Practice Address - Country:US
Practice Address - Phone:903-247-3400
Practice Address - Fax:903-238-9183
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BF102OtherBCBSTX
TX8F3749Medicare PIN
TX8BF102OtherBCBSTX