Provider Demographics
NPI:1619150349
Name:AULL, CODY BOYD (DO)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:BOYD
Last Name:AULL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-689-4703
Mailing Address - Fax:877-647-0202
Practice Address - Street 1:1515 N FLAGLER DR STE 600
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3430
Practice Address - Country:US
Practice Address - Phone:561-513-6342
Practice Address - Fax:561-513-6343
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23702207Y00000X, 207YS0123X
FL17340207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007034875OtherSTATE OF MISSOURI