Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | P1175 | TX |
NPI | 1093933871 |
---|---|
Provider Name | Dr. Courtney Holt Cowden III |
First Address | Lubbock, TX 79410-1314 |
Second Address | Lubbock, TX 79410-1212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 24/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
324631602 | (05) | TX |
8FX315 | BCBS TX (01) | TX |
970223101 | FIRSTCARE (01) | TX |