Provider Demographics
NPI:1003974262
Name:COX, BLYTHE ELIZABETH (PA C)
Entity Type:Individual
Prefix:MRS
First Name:BLYTHE
Middle Name:ELIZABETH
Last Name:COX
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:BLYTHE
Other - Middle Name:E
Other - Last Name:KAPPUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4771
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001
Mailing Address - Country:US
Mailing Address - Phone:307-734-9510
Mailing Address - Fax:
Practice Address - Street 1:555 E BROADWAY
Practice Address - Street 2:SUITE 229
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-732-1039
Practice Address - Fax:307-732-1041
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine