MEDICARE: DR. ANTHONY COSTALES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	S2006	TX
2	207VX0201X	Gynecologic Oncology Physician	S2006	TX

General Provider Information

NPI Number	:	1578828703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY COSTALES M.D.

Provider Business Mailing Address
First Line	:	2000 LAMBERT CT
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-2901
Country	:	US
Telephone Number	:	214-728-5940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 OLD SPANISH TRL FL 7
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2003
Country	:	US
Telephone Number	:	713-798-1999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	07/01/2024

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