Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | H5160 | TX |
NPI | 1083652291 |
---|---|
Provider Name | Dr. Dennis James Costa |
First Address | Dallas, TX 75391-1230 |
Second Address | Lewisville, TX 75067-3884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 25/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137791301 | (05) | TX |
137791303 | (05) | TX |
137791304 | (05) | TX |
137791305 | (05) | TX |
137791306 | (05) | TX |
137791307 | (05) | TX |
137791308 | (05) | TX |
137791309 | (05) | TX |
137791311 | (05) | TX |
8R1416 | BLUE CROSS OF TEXAS (01) | TX |
F69285 | (02) |