Healthcare Provider Details

I. General information

NPI: 1326030131
Provider Name (Legal Business Name): DONNA RAYE COSBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 S MUSTANG RD
YUKON OK
73099-9585
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 405-376-1800
  • Fax: 405-376-1856
Mailing address:
  • Phone: 405-376-1800
  • Fax: 405-376-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15742
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: