Provider Demographics
NPI:1699183145
Name:GULF COAST PHYSICAL MEDICINE PLLC
Entity Type:Organization
Organization Name:GULF COAST PHYSICAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANON
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-948-4111
Mailing Address - Street 1:8800 KATY FWY STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1645
Mailing Address - Country:US
Mailing Address - Phone:832-831-8656
Mailing Address - Fax:832-831-8674
Practice Address - Street 1:8800 KATY FWY
Practice Address - Street 2:SUITE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1633
Practice Address - Country:US
Practice Address - Phone:832-831-8656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381036Medicare PIN