Basic Information
| Provider Information | |||||||||
| NPI: | 1205148376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOURIAL | ||||||||
| FirstName: | SOURIAL | ||||||||
| MiddleName: | MORRIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6520 FORT CAROLINE RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322772044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047453618 | ||||||||
| FaxNumber: | 9047227421 | ||||||||
| Practice Location | |||||||||
| Address1: | 6484 FORT CAROLINE RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322772042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047447300 | ||||||||
| FaxNumber: | 9047224271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2010 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 257585 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 208VP0000X | OS11425 | FL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | OS11425 | FL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207Q00000X | OS11425 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.