Provider Demographics
NPI:1235693151
Name:COX, MARVIN D (MSW)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:D
Last Name:COX
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27TH MEDICAL GROUP/SGHC
Mailing Address - Street 2:224 W D.L. INGRAM AVE
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5103
Mailing Address - Country:US
Mailing Address - Phone:575-904-3917
Mailing Address - Fax:575-784-6028
Practice Address - Street 1:27TH MEDICAL GROUP
Practice Address - Street 2:224 W D.L. INGRAM AVE
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5103
Practice Address - Country:US
Practice Address - Phone:575-784-1108
Practice Address - Fax:575-784-6028
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-10381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker