MEDICARE: MESQUITE MEDICAL ASSOCIATES,LTD

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	207R00000X	Internal Medicine Physician	7826	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0010610	OTHER		BCBS

General Provider Information

NPI Number	:	1609876499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESQUITE MEDICAL ASSOCIATES,LTD

Provider Business Mailing Address
First Line	:	1830 MESQUITE AVE
Second Line	:	STE. A
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5885
Country	:	US
Telephone Number	:	928-855-8071
Fax Number	:	928-855-6869

Provider Business Practice Location Address
First Line	:	1830 MESQUITE AVE
Second Line	:	STE. A
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5885
Country	:	US
Telephone Number	:	928-855-8071
Fax Number	:	928-855-6869

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. WALTER K. SOSEY
Credential	:	M.D.
Telephone Number	:	928-855-8071

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	11/13/2007

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Directions to “MESQUITE MEDICAL ASSOCIATES,LTD ” Practice Location

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