MEDICARE: DR. PEDRO EUGENIO COSCULLUELA MD

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	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	M6580	TX

General Provider Information

NPI Number	:	1588693386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRO EUGENIO COSCULLUELA MD

Provider Business Mailing Address
First Line	:	900 W 38TH ST STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1130
Country	:	US
Telephone Number	:	512-450-1300
Fax Number	:	512-450-1339

Provider Business Practice Location Address
First Line	:	900 W 38TH ST STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1130
Country	:	US
Telephone Number	:	512-450-1330
Fax Number	:	512-450-1339

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	04/18/2024

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