Provider Demographics
NPI:1275558611
Name:SOSA, ISAAC (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:SOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ISAAC
Other - Middle Name:
Other - Last Name:SOSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1195 GARNER FIELD RD. STE 300
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801
Mailing Address - Country:US
Mailing Address - Phone:830-278-3086
Mailing Address - Fax:830-278-8873
Practice Address - Street 1:1195 GARNER FIELD RD. STE 500
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801
Practice Address - Country:US
Practice Address - Phone:830-278-3027
Practice Address - Fax:830-278-3089
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7829207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138814206Medicaid
TX86590NOtherBLUE CROSS BLUE SHIELD
TX86590NOtherBLUE CROSS BLUE SHIELD
TX742917788OtherTAX ID NUMBER
TX86590NOtherBLUE CROSS BLUE SHIELD