Provider Demographics
NPI:1861139362
Name:KEVIN ALAN COX, DPM, PODIATRY CORPORATION
Entity type:Organization
Organization Name:KEVIN ALAN COX, DPM, PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-451-5752
Mailing Address - Street 1:8851 CENTER DR # 406
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3017
Mailing Address - Country:US
Mailing Address - Phone:619-465-3200
Mailing Address - Fax:619-465-3700
Practice Address - Street 1:8851 CENTER DR # 406
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-465-3200
Practice Address - Fax:619-465-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty