Healthcare Provider Details

I. General information

NPI: 1639287600
Provider Name (Legal Business Name): KERRY DUANE COX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 39 & YY
SHELL KNOB MO
65747
US

IV. Provider business mailing address

3800 S NATIONAL AVE #540
SPRINGFIELD MO
65807-5209
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-2470
  • Fax: 417-858-6910
Mailing address:
  • Phone: 417-269-6262
  • Fax: 417-269-4349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11321
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: