MEDICARE: KENT WALTER COX MD PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	24584	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013177468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT WALTER COX MD PS

Provider Business Mailing Address
First Line	:	5448 WHITE MOUNTAIN BLVD
Second Line	:	SUITE 140
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5739
Country	:	US
Telephone Number	:	928-532-0072
Fax Number	:	928-532-0078

Provider Business Practice Location Address
First Line	:	5448 WHITE MOUNTAIN BLVD
Second Line	:	SUITE 140
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5739
Country	:	US
Telephone Number	:	928-532-0072
Fax Number	:	928-532-0078

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENT W. COX
Credential	:	M.D.
Telephone Number	:	928-532-0072

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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