Provider Demographics
NPI:1285981332
Name:SOSA POPOTEUR, JOSE M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:SOSA POPOTEUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:M
Other - Last Name:SOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6410
Mailing Address - Fax:223-934-3401
Practice Address - Street 1:16261 BASS RD STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3671
Practice Address - Country:US
Practice Address - Phone:239-343-6410
Practice Address - Fax:239-343-4014
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139059207RC0000X
MS29351207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07331505Medicaid
FL112321200Medicaid