Healthcare Provider Details

I. General information

NPI: 1053315408
Provider Name (Legal Business Name): GARY WAYNE COX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8425 CUMBERLAND PL
BATON ROUGE LA
70806-6544
US

IV. Provider business mailing address

8425 CUMBERLAND PL
BATON ROUGE LA
70806-6544
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-7514
  • Fax: 225-930-0987
Mailing address:
  • Phone: 225-924-7514
  • Fax: 225-930-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number10369R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: