Provider Demographics
NPI:1548252109
Name:COX, KENT W (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:W
Last Name:COX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5448 WHITE MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5739
Mailing Address - Country:US
Mailing Address - Phone:928-532-0072
Mailing Address - Fax:928-532-0078
Practice Address - Street 1:5448 WHITE MOUNTAIN BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5739
Practice Address - Country:US
Practice Address - Phone:928-532-0072
Practice Address - Fax:928-532-0078
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2008-06-10
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Provider Licenses
StateLicense IDTaxonomies
AZ24584207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2245796OtherCCN
AZ2Z1140OtherHEALTHNET
AZ153886OtherRAN
AZ431057Medicaid
AZAZ0824160OtherBLUE CROSS BLUE SHIELD
AZ431057Medicaid
AZ2245796OtherCCN