Individual
GILBERTO SOSTRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH STREET, DEPARTMENT OF RADIOLOGY, AUGUSTA, GA 30912-0004
(706) 721-9729
(706) 721-8507
Mailing address
1499 WALTON WAY, SUITE 1400, PROVIDER ENROLLMENT, AUGUSTA, GA 30901-2602
(706) 828-8401
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
023684
GA
2085R0202X
Diagnostic Radiology Physician
Primary
023684
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000892482A
—
GA
05
—
G23684
—
SC
Enumeration date
08/31/2006
Last updated
03/01/2017
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