Provider Demographics
NPI:1699266791
Name:COSGRAVE, CORY GUNN (DO)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:GUNN
Last Name:COSGRAVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 W SUNSET BLVD STE 94
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6792
Mailing Address - Country:US
Mailing Address - Phone:435-709-8786
Mailing Address - Fax:435-921-4843
Practice Address - Street 1:1930 W SUNSET BLVD STE 94
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6792
Practice Address - Country:US
Practice Address - Phone:435-709-8786
Practice Address - Fax:435-921-4843
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16862207QS0010X
UT7205746-8904207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine