Individual
DR. SERGIO EDUARDO SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(219) 916-2888
Mailing address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(219) 916-2888
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0101238938
VA
207LP2900X
Pain Medicine (Anesthesiology) Physician
35090134
OH
208VP0014X
Interventional Pain Medicine Physician
Primary
M5517
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8CZ439
BLUE CROSS/BLUE SHIELD
TX
05
—
PENDING
—
TX
Enumeration date
06/15/2006
Last updated
12/05/2013
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