Provider Demographics
NPI:1437122553
Name:SOS, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:SOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8575 E PRINCESS DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5483
Mailing Address - Country:US
Mailing Address - Phone:480-496-2696
Mailing Address - Fax:480-264-7012
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:SUITE 117
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:480-496-2696
Practice Address - Fax:480-264-7012
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ965410Medicaid
I41673Medicare UPIN
AZ105428Medicare ID - Type Unspecified