Provider Demographics
NPI:1538153564
Name:COX, JACQUELINE ANN (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1640 COWLES ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5925
Mailing Address - Country:US
Mailing Address - Phone:907-452-4768
Mailing Address - Fax:907-452-1009
Practice Address - Street 1:1640 COWLES ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5992
Practice Address - Country:US
Practice Address - Phone:907-452-4768
Practice Address - Fax:907-452-1009
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK5565207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD 6153Medicaid
AKK162480Medicare PIN
AKMD 6153Medicaid
G80242Medicare UPIN