MEDICARE: DAVID M COSS 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	207Q00000X	Family Medicine Physician	E-3890	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04030012800	OTHER		QUALCHOICE OF ARKANSAS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5M781	OTHER	AR	BLUE CROSS BLUE SHIELD
4	300800	OTHER		CIGNA HEALTH CARE

General Provider Information

NPI Number	:	1851340939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M COSS M.D.

Provider Business Mailing Address
First Line	:	904 HOLIDAY DR
Second Line	:	SUITE 404
City	:	FORREST CITY
State	:	AR
Zip	:	72335-9183
Country	:	US
Telephone Number	:	870-630-1683
Fax Number	:	870-630-0308

Provider Business Practice Location Address
First Line	:	904 HOLIDAY DR
Second Line	:	SUITE 404
City	:	FORREST CITY
State	:	AR
Zip	:	72335-9183
Country	:	US
Telephone Number	:	870-630-1683
Fax Number	:	870-630-0308

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	07/08/2007

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Directions to “ DAVID M COSS M.D.” Practice Location

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