MEDICARE: JOSE ALFREDO SOSA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA3654	FL
2	363AS0400X	Surgical Physician Assistant	PA00039	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	347887903	OTHER		TRICARE

General Provider Information

NPI Number	:	1508881822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ALFREDO SOSA PA-C

Provider Business Mailing Address
First Line	:	7048 OLD CANTON RD STE 2E
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-1021
Country	:	US
Telephone Number	:	601-992-9790
Fax Number	:	601-992-9796

Provider Business Practice Location Address
First Line	:	7048 OLD CANTON RD STE 2E
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-1021
Country	:	US
Telephone Number	:	601-992-9790
Fax Number	:	601-992-9796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	01/27/2026

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