Provider Demographics
NPI:1104850098
Name:COX, KURTIS (MD)
Entity Type:Individual
Prefix:
First Name:KURTIS
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:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-781-6845
Mailing Address - Fax:417-781-5024
Practice Address - Street 1:1020 MCINTOSH CIRCLE
Practice Address - Street 2:STE 102
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-781-6845
Practice Address - Fax:417-781-5024
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107638208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106802OtherANTHEM
G02450Medicare UPIN