Provider Demographics
NPI:1043424237
Name:COX, BRENT TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:TAYLOR
Last Name:COX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2330
Mailing Address - Country:US
Mailing Address - Phone:707-763-2801
Mailing Address - Fax:707-766-8831
Practice Address - Street 1:111 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2330
Practice Address - Country:US
Practice Address - Phone:707-763-2801
Practice Address - Fax:707-766-8831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34594103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45993Medicare UPIN