Provider Demographics
NPI:1073545497
Name:COX, DALE JACKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:JACKSON
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 1:198 W CHERRY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3506
Mailing Address - Country:US
Mailing Address - Phone:559-782-1871
Mailing Address - Fax:559-782-1874
Practice Address - Street 1:198 W CHERRY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3506
Practice Address - Country:US
Practice Address - Phone:559-782-1871
Practice Address - Fax:559-782-1874
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18002207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G180020Medicaid
CA00G180020Medicaid
CA00G180020Medicare ID - Type Unspecified