Provider Demographics
NPI:1508223199
Name:COWANS, DERICK ANDREW (CSA)
Entity Type:Individual
Prefix:
First Name:DERICK
Middle Name:ANDREW
Last Name:COWANS
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:DERICK
Other - Middle Name:
Other - Last Name:COWANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSFA
Mailing Address - Street 1:2800 TRANQUILITY LAKE BLVD
Mailing Address - Street 2:SUITE 2311
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4658
Mailing Address - Country:US
Mailing Address - Phone:832-872-3794
Mailing Address - Fax:
Practice Address - Street 1:10223 BROADWAY ST
Practice Address - Street 2:SUITE P-284
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7880
Practice Address - Country:US
Practice Address - Phone:832-248-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant