Healthcare Provider Details

I. General information

NPI: 1437339454
Provider Name (Legal Business Name): BRENT M. ADCOX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BARTLETT ST STE 201
HOMER AK
99603-7015
US

IV. Provider business mailing address

4201 BARTLETT ST STE 201
HOMER AK
99603-7015
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-0310
  • Fax: 907-235-0276
Mailing address:
  • Phone: 907-235-0310
  • Fax: 907-235-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberM9771
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number7215
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: