Individual
CORY NATHAN COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4800 HEDGCOXE RD STE 200, PLANO, TX 75024-2402
(469) 800-6120
(469) 800-6129
Mailing address
4800 HEDGCOXE RD STE 200, PLANO, TX 75024-2402
(469) 800-6120
(469) 800-6129
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34362
TN
207Q00000X
Family Medicine Physician
Primary
S3145
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34362
STATE LICENSE
TN
01
—
S3145
TEXAS MEDICAL BOARD
TX
Enumeration date
12/02/2006
Last updated
01/03/2020
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