Provider Demographics
NPI:1235257429
Name:COSGROVE, DANIEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SCOTT
Last Name:COSGROVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45200 CLUB DR STE A
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-8837
Mailing Address - Country:US
Mailing Address - Phone:760-777-8772
Mailing Address - Fax:760-477-6002
Practice Address - Street 1:45200 CLUB DR STE A
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-8837
Practice Address - Country:US
Practice Address - Phone:760-777-8772
Practice Address - Fax:760-477-6002
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG478502083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG47850OtherCA MEDICAL LICENSE NUMBER
CAG47850OtherCA MEDICAL LICENSE NUMBER
CAA50835Medicare UPIN
CAG47850OtherCA MEDICAL LICENSE NUMBER