Individual
MR. DANIEL THOMAS COSGRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2275 NE DOCTORS DR STE 6, BEND, OR 97701-6092
(541) 706-6915
(541) 706-6733
Mailing address
PO BOX 5579, BEND, OR 97708-5579
(541) 706-6915
(541) 706-2991
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA00492
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00492
PROFESSIONAL LICENSE NUMBER
OR
Enumeration date
12/07/2005
Last updated
03/17/2021
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