Provider Demographics
NPI:1942276555
Name:SOSEY, WALTER K (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:K
Last Name:SOSEY
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 1:1830 MESQUITE AVE #A
Mailing Address - Street 2:
Mailing Address - City:LK HAVASU CTY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5885
Mailing Address - Country:US
Mailing Address - Phone:928-855-8071
Mailing Address - Fax:928-855-6869
Practice Address - Street 1:1830 MESQUITE AVE #A
Practice Address - Street 2:
Practice Address - City:LK HAVASU CTY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5885
Practice Address - Country:US
Practice Address - Phone:928-855-8071
Practice Address - Fax:928-855-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD00352Medicare UPIN
AZZ0000BGFFCMedicare PIN