Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 12556 | TX |
NPI | 1003825100 |
---|---|
Provider Name | Dr. Michael D Cosgrove |
First Address | Fort Worth, TX 76104-2937 |
Second Address | Fort Worth, TX 76104-2937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 08/07/2007 |