Gregory Wade Cowart, CRNA

Individual provider Active NPI Certified Registered Nurse Anesthetist · Port Lavaca, TX

NPI 1528070885 · NPPES record last updated Jul 9, 2007

Key facts

NPI
1528070885
Entity type
Individual (NPI type 1)
Primary specialty
Certified Registered Nurse Anesthetist 367500000X
License
239435 (TX)
Practice address
815 N Virginia St
Port Lavaca, TX 77979-3025
Phone
(361) 552-6713
Fax
(361) 552-0338
NPI assigned
Aug 13, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
239435TXMDCertified Registered Nurse Anesthetist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 239435 TX Yes

Addresses

Primary practice location

815 N Virginia St
Port Lavaca, TX 77979-3025

Mailing address

38402 Wildwood PT
Magnolia, TX 77354-6643
Phone (713) 302-5036

Other providers in Port Lavaca, TX

All providers in Port Lavaca, TX · Certified Registered Nurse Anesthetist in Texas

Sources for this page

Verify at the official NPI Registry.