Basic Information
| Provider Information | |||||||||
| NPI: | 1043400757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOSA | ||||||||
| FirstName: | SAMETA | ||||||||
| MiddleName: | FAIRCHILD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FAIRCHILD | ||||||||
| OtherFirstName: | SAMETA | ||||||||
| OtherMiddleName: | SHRAUNER | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1017 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788013501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302610886 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 124 ROYAL LN | ||||||||
| Address2: | |||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302786691 | ||||||||
| FaxNumber: | 8302787533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2007 | ||||||||
| LastUpdateDate: | 12/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2007016408 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | N9962 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.