Provider Demographics
NPI:1285850727
Name:CODY, MADELEINE G (PA-C)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:G
Last Name:CODY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 HIGHLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4233
Mailing Address - Country:US
Mailing Address - Phone:405-990-6640
Mailing Address - Fax:
Practice Address - Street 1:10815 RR 2222
Practice Address - Street 2:BLDG 3A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1159
Practice Address - Country:US
Practice Address - Phone:512-327-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05587363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant