Provider Demographics
NPI:1053361055
Name:CULWELL, CODY (MD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:CULWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014-3315
Mailing Address - Country:US
Mailing Address - Phone:806-323-8882
Mailing Address - Fax:806-323-6108
Practice Address - Street 1:1010 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014-3315
Practice Address - Country:US
Practice Address - Phone:806-323-8882
Practice Address - Fax:806-323-6108
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7616207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175295801Medicaid
TX175295801Medicaid
I24597Medicare UPIN