Provider Demographics
NPI:1114030509
Name:COX, SHIRLEY
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 RIDGE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2569
Mailing Address - Country:US
Mailing Address - Phone:972-722-4045
Mailing Address - Fax:972-722-4087
Practice Address - Street 1:2504 RIDGE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2569
Practice Address - Country:US
Practice Address - Phone:972-722-4045
Practice Address - Fax:972-722-4087
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0067958332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531459OtherBCBS TEXAS
4781880001Medicare NSC