Basic Information
| Provider Information | |||||||||
| NPI: | 1528070885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COWART | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | WADE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38402 WILDWOOD PT | ||||||||
| Address2: | |||||||||
| City: | MAGNOLIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773546643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133025036 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 N VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | PORT LAVACA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779793025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615526713 | ||||||||
| FaxNumber: | 3615520338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 239435 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.