Provider Demographics
NPI:1710926407
Name:SOSNOWSKI, JEFFREY S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:SOSNOWSKI
Suffix:
Gender:M
Credentials:MD, PHD
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 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:PATHOLOGY
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7790
Practice Address - Fax:251-471-7715
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26590207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09808729Medicaid
LA1720798Medicaid
MS09808729Medicaid
LA1720798Medicaid