Healthcare Provider Details

I. General information

NPI: 1336081769
Provider Name (Legal Business Name): EZEKIEL COSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E 32ND ST
AUSTIN TX
78705-2703
US

IV. Provider business mailing address

556 CHINKAPIN TRL
NEW BRAUNFELS TX
78132-2980
US

V. Phone/Fax

Practice location:
  • Phone: 512-544-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number789791008
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: