Provider Demographics
NPI:1720041916
Name:SOSA, RODNEY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:WAYNE
Last Name:SOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 WOODBURY CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8303
Mailing Address - Country:US
Mailing Address - Phone:972-352-0920
Mailing Address - Fax:
Practice Address - Street 1:2009 WOODBURY CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8303
Practice Address - Country:US
Practice Address - Phone:972-352-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00714ZMedicare ID - Type Unspecified
TXG68123Medicare UPIN
TX00714ZMedicare PIN