Healthcare Provider Details

I. General information

NPI: 1770502387
Provider Name (Legal Business Name): THOMAS BERNARD COX P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 N. MAIN STREET
CEDAR SPRINGS MI
49319
US

IV. Provider business mailing address

261 N. MAIN STREET PO BOX 221K
CEDAR SPRINGS MI
49319
US

V. Phone/Fax

Practice location:
  • Phone: 616-696-2020
  • Fax: 616-696-4860
Mailing address:
  • Phone: 616-696-2020
  • Fax: 616-696-4860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003211
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: