Provider Demographics
NPI:1508881822
Name:SOSA, JOSE ALFREDO (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALFREDO
Last Name:SOSA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 N STATE ST
Mailing Address - Street 2:DEPT. OF SURGERY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2064
Mailing Address - Country:US
Mailing Address - Phone:601-968-6137
Mailing Address - Fax:601-968-4133
Practice Address - Street 1:1225 N STATE ST
Practice Address - Street 2:DEPT. OF SURGERY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2064
Practice Address - Country:US
Practice Address - Phone:601-968-6137
Practice Address - Fax:601-968-4133
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA039363AS0400X
FLPA3654363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08478237Medicaid
347887903OtherTRICARE
MS970000021Medicare ID - Type Unspecified
P09769Medicare UPIN