Provider Demographics
NPI:1093904823
Name:COX, JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
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 1:237 WILLIAM HOWARD TAFT, PHYS DIV
Mailing Address - Street 2:2ND FL, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-263-8571
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-721-7373
Practice Address - Fax:513-977-4253
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57013394208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH774715OtherANTHEM
OH1628618OtherGATEWAY
OH777801OtherBUCKEYE MEDICARE
OHH118270OtherMEDICARE
KYP01267522OtherRAILROAD KY MEDICARE
OH77226OtherMEDICAID
KYK066180OtherKY MEDICARE
OH712962OtherBUCKEYE MEDICAID
OH714390OtherWELLCARE OF OH
OH270577733074OtherCARESOURCE
KY7100208720OtherMEDICAID
KY146419OtherCOVENTRY CARES OF KY
OHP01238532OtherRAILROAL OH MEDICARE