Provider Demographics
NPI:1003080763
Name:COSSEY, LARRY NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NICHOLAS
Last Name:COSSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10810 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4354
Mailing Address - Country:US
Mailing Address - Phone:501-604-2695
Mailing Address - Fax:
Practice Address - Street 1:10810 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4354
Practice Address - Country:US
Practice Address - Phone:501-604-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7326207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology