Provider Demographics
NPI:1912997347
Name:COSBY, PHILLIP DWIGHT (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:DWIGHT
Last Name:COSBY
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2415 TREE BR
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2646
Mailing Address - Country:US
Mailing Address - Phone:210-566-1333
Mailing Address - Fax:
Practice Address - Street 1:12501 JUDSON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-4103
Practice Address - Country:US
Practice Address - Phone:210-656-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical