=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225065642
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY H COX MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2006
-----------------------------------------------------
Last Update Date | 12/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 616 CAMPUS DRIVE SUITE 300
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24210-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-739-0067
-----------------------------------------------------
Fax | 276-739-0069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 W STONE DR SUITE 6A
-----------------------------------------------------
City | KINGSPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37660-3365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-408-7220
-----------------------------------------------------
Fax | 423-408-7405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 12378
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------