Provider Demographics
NPI:1528070885
Name:COWART, GREGORY WADE (CRNA)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:WADE
Last Name:COWART
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38402 WILDWOOD PT
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-6643
Mailing Address - Country:US
Mailing Address - Phone:713-302-5036
Mailing Address - Fax:
Practice Address - Street 1:815 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3025
Practice Address - Country:US
Practice Address - Phone:361-552-6713
Practice Address - Fax:361-552-0338
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239435367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G5537Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER