Provider Demographics
NPI:1588731731
Name:SOUSA, JOSE J (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:SOUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 HANOVER ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5299
Mailing Address - Country:US
Mailing Address - Phone:508-679-8591
Mailing Address - Fax:508-679-8630
Practice Address - Street 1:235 HANOVER ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5299
Practice Address - Country:US
Practice Address - Phone:508-679-8591
Practice Address - Fax:508-679-8630
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA349182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2024942Medicaid
MA2024942Medicaid
K17006Medicare ID - Type Unspecified