Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 6692924 | AZ |
NPI | 1013485762 |
---|---|
Provider Name | Dr. Todd Charles Coslett |
First Address | Phoenix, AZ 85051-7329 |
Second Address | Phoenix, AZ 85055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2018 |
Last Update Date | 09/11/2018 |