MEDICARE: WALTER K SOSEY MD

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

General Provider Information

NPI Number	:	1942276555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER K SOSEY MD

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

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	11/20/2007

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