Provider Demographics
NPI:1881799880
Name:SOSA, FELIX ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:FELIX
Middle Name:ANTHONY
Last Name:SOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FELIX
Other - Middle Name:A
Other - Last Name:SOSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:780 E MERRITT ISLAND CSWY STE 6C
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3562
Mailing Address - Country:US
Mailing Address - Phone:321-631-5555
Mailing Address - Fax:321-262-0836
Practice Address - Street 1:780 E MERRITT ISLAND CSWY STE 6C
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3562
Practice Address - Country:US
Practice Address - Phone:321-631-5555
Practice Address - Fax:321-262-0836
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4524568OtherAETNA
FL110185763OtherMEDICARE RAILROAD
FL25661OtherBCBS
FL10D0955954OtherCLIA
FL272495200Medicaid
FL1881799880OtherMEDICARE INDIVIDUAL NPI #
FLME66702OtherMEDICAL LICENSE
169057008OtherCIGNA
FL593523890OtherTAX IDENTIFICATION NUMBER
FLEH778AOtherMEDICARE GROUP NPI PTAN
FL1174827919OtherMEDICARE GROUP NPI #
BS4154566OtherDEA
FLME66702OtherMEDICAL LICENSE
FL593523890OtherTAX IDENTIFICATION NUMBER