=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417482761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY LYNN COX PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2017
-----------------------------------------------------
Last Update Date | 06/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1579 W GURLEY ST STE A-39
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86305-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-440-2080
-----------------------------------------------------
Fax | 928-440-8141
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1579 W GURLEY ST STE A-39
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86305-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-440-2080
-----------------------------------------------------
Fax | 928-440-8141
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 10385
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------