Provider Demographics
NPI:1205148376
Name:SOURIAL, SOURIAL MORRIS (DO)
Entity type:Individual
Prefix:DR
First Name:SOURIAL
Middle Name:MORRIS
Last Name:SOURIAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10689 TOWN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4026
Mailing Address - Country:US
Mailing Address - Phone:917-940-7644
Mailing Address - Fax:
Practice Address - Street 1:9770 OLD BAYMEADOWS RD STE 141
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7986
Practice Address - Country:US
Practice Address - Phone:904-944-2124
Practice Address - Fax:888-241-3383
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11425207QA0505X, 208VP0014X, 208VP0000X, 207Q00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355974202Medicaid