Provider Demographics
NPI:1396242731
Name:GUGGENMOS, CODY (DO)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:GUGGENMOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8911 N CAPITAL OF TEXAS HWY STE 1110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7203
Mailing Address - Country:US
Mailing Address - Phone:772-795-9608
Mailing Address - Fax:877-384-3106
Practice Address - Street 1:1610 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8948
Practice Address - Country:US
Practice Address - Phone:877-279-5960
Practice Address - Fax:877-384-3106
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-45085207Q00000X
CO0063615207Q00000X
AZ010719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty