Provider Demographics
NPI:1194962910
Name:HUMBERTO J. SOSA, MD, PA
Entity type:Organization
Organization Name:HUMBERTO J. SOSA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-394-1600
Mailing Address - Street 1:300 CRESTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-5515
Mailing Address - Country:US
Mailing Address - Phone:479-394-1600
Mailing Address - Fax:479-394-1606
Practice Address - Street 1:300 CRESTWOOD CIR
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-5515
Practice Address - Country:US
Practice Address - Phone:479-394-1600
Practice Address - Fax:479-394-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4241207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120117001Medicaid