Provider Demographics
NPI:1275502833
Name:MCFADDEN, SOPHIA CONCEPCION (MD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:CONCEPCION
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:CONCEPCION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1507 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1024
Mailing Address - Country:US
Mailing Address - Phone:254-865-8251
Mailing Address - Fax:254-248-6306
Practice Address - Street 1:1507 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-1024
Practice Address - Country:US
Practice Address - Phone:254-865-8251
Practice Address - Fax:254-248-6306
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025366207R00000X
TXM4339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine