Provider Demographics
NPI:1083821318
Name:COX, DEREK SHANE (ARRT ( R ) , ARDMS)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:SHANE
Last Name:COX
Suffix:
Gender:M
Credentials:ARRT ( R ) , ARDMS
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Mailing Address - Street 1:1161 PALO VERDE PL
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-1462
Mailing Address - Country:US
Mailing Address - Phone:928-505-1747
Mailing Address - Fax:
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TUBA
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:928-283-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRT-90122471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography