Provider Demographics
NPI:1154317592
Name:COZAD, CATHERINE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:LOUISE
Last Name:COZAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1251
Mailing Address - Country:US
Mailing Address - Phone:727-518-1121
Mailing Address - Fax:727-585-7357
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1251
Practice Address - Country:US
Practice Address - Phone:727-518-1121
Practice Address - Fax:727-585-7357
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53488207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048329000Medicaid
1319OtherHUMANA
5950034OtherAETNA
07669OtherBLUE CROSS BLUE SHIELD
160055408OtherRAILROAD MEDICARE
E56523Medicare UPIN
07669AMedicare ID - Type Unspecified