Provider Demographics
NPI:1073582821
Name:COX, BRENNON K (DO)
Entity Type:Individual
Prefix:
First Name:BRENNON
Middle Name:K
Last Name:COX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1705 E 19TH ST
Mailing Address - Street 2:302
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5405
Mailing Address - Country:US
Mailing Address - Phone:918-744-2362
Mailing Address - Fax:918-293-3180
Practice Address - Street 1:1802 E 19TH ST
Practice Address - Street 2:400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5425
Practice Address - Country:US
Practice Address - Phone:918-748-7644
Practice Address - Fax:918-293-3184
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2007-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK3940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200018170AMedicaid
OK200018170AMedicaid
OK241422901Medicare PIN