MEDICARE: DANIEL L COX JR. PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9103696	FL

General Provider Information

NPI Number	:	1063440162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL L COX JR. PAC

Provider Business Mailing Address
First Line	:	PO BOX 1770
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32402
Country	:	US
Telephone Number	:	850-747-4900
Fax Number	:	850-747-4907

Provider Business Practice Location Address
First Line	:	527 N PALO ALTO AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3639
Country	:	US
Telephone Number	:	850-747-4905
Fax Number	:	850-747-4907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	05/20/2011

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