Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M6580 | TX |
NPI | 1588693386 |
---|---|
Provider Name | Dr. Pedro Eugenio Cosculluela |
First Address | Houston, TX 77030-2750 |
Second Address | Houston, TX 77030-2750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 15/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I55482 | (02) |