Provider Demographics
NPI:1083682777
Name:COX, PAMELA LAURA (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LAURA
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4986 N ADAMS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1416
Mailing Address - Country:US
Mailing Address - Phone:248-475-5601
Mailing Address - Fax:248-475-5632
Practice Address - Street 1:4986 N ADAMS RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1416
Practice Address - Country:US
Practice Address - Phone:248-475-5601
Practice Address - Fax:248-475-5632
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049639208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301049639OtherLICENSE NUMBER
F07600Medicare UPIN