Provider Demographics
NPI:1841594231
Name:GILBERTO SOSA JR MD PA
Entity Type:Organization
Organization Name:GILBERTO SOSA JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:361-592-8533
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78364-1083
Mailing Address - Country:US
Mailing Address - Phone:361-592-8533
Mailing Address - Fax:361-595-7982
Practice Address - Street 1:1311 GENERAL CAVAZOS BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7150
Practice Address - Country:US
Practice Address - Phone:361-592-8533
Practice Address - Fax:361-595-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091794001Medicaid
TXB26576Medicare UPIN