Provider Demographics
NPI:1003569096
Name:COX, LARRY DEWAYNE JR
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DEWAYNE
Last Name:COX
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SANDY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-3020
Mailing Address - Country:US
Mailing Address - Phone:863-242-9130
Mailing Address - Fax:
Practice Address - Street 1:232 SANDY RIDGE DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-3020
Practice Address - Country:US
Practice Address - Phone:863-242-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities