Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 215852 | NY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | OS8239 | FL |
NPI | 1104854652 |
---|---|
Provider Name | John Lemual Cosby |
First Address | Coral Gables, FL 33134-2060 |
Second Address | Coral Gables, FL 33134-2060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 13/05/2015 |