Provider Demographics
NPI:1194816041
Name:SOSA, JAVIER ENID (MD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:ENID
Last Name:SOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:9400 GLADIOLUS DR STE 50
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9615
Practice Address - Country:US
Practice Address - Phone:239-437-7070
Practice Address - Fax:239-437-9022
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12924OtherFL BC
FL12924OtherFL BC
FLF01271Medicare UPIN