1942459250 NPI number — MR. DANNY LEE COSBY CAP/SAP

Table of content: MR. DANNY LEE COSBY CAP/SAP (NPI 1942459250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942459250 NPI number — MR. DANNY LEE COSBY CAP/SAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSBY
Provider First Name:
DANNY
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CAP/SAP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942459250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6919 GRAY OAK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33578-4599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-690-7238
Provider Business Mailing Address Fax Number:
813-672-0375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6919 GRAY OAK PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33578-4599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-690-7238
Provider Business Practice Location Address Fax Number:
813-672-0375
Provider Enumeration Date:
09/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CAP-2655 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: SAP - 13142 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)