Healthcare Provider Details

I. General information

NPI: 1053313171
Provider Name (Legal Business Name): MARCUS F COX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BELLEFONTAINE AVE SUITE 260
LIMA OH
45804-2851
US

IV. Provider business mailing address

1005 BELLEFONTAINE AVE SUITE 260
LIMA OH
45804-2851
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-8250
  • Fax: 419-998-8251
Mailing address:
  • Phone: 419-998-8250
  • Fax: 419-998-8251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number082114
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number82114
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number082114
License Number StateOH

VII. Legacy identifiers

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

# 1
IdentifierP00185444
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier2410993
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: