Provider Demographics
NPI:1033230743
Name:COX, ROGER E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:E
Last Name:COX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 GRAND PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7700
Mailing Address - Country:US
Mailing Address - Phone:916-543-8572
Mailing Address - Fax:
Practice Address - Street 1:1814 GRAND PHEASANT LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7700
Practice Address - Country:US
Practice Address - Phone:916-543-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19761208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice