Provider Demographics
NPI:1619073459
Name:SOBIERAJ, ALISSA (PAC)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:SOBIERAJ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-683-2338
Mailing Address - Fax:940-683-2394
Practice Address - Street 1:2202 US HIGHWAY 380 STE 112
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2177
Practice Address - Country:US
Practice Address - Phone:940-683-2338
Practice Address - Fax:940-683-2394
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00992363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX298221701Medicaid
TX8N0296OtherBCBSTX
TXPENDINGMedicare PIN