Provider Demographics
NPI:1255478525
Name:COX, PATRICK RUSSELL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RUSSELL
Last Name:COX
Suffix:
Gender:M
Credentials:MD, PHD
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 1418
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1418
Mailing Address - Country:US
Mailing Address - Phone:541-758-5047
Mailing Address - Fax:800-672-7210
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO478112085R0202X
IDM-122992085R0202X
AK78552085R0202X
WAMD601455732085R0202X
ORMD1675982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA263396OtherLNI PROVIDER ID
CO31574793Medicaid
WA332253OtherLNI PROVIDER ID
WA332252OtherLNI PROVIDER ID
OR500718365Medicaid
AK1610158Medicaid
ID1255478525Medicaid
WA332255OtherLNI PROVIDER ID
WA2007776Medicaid
WAG8918769Medicare PIN
WAG8918709Medicare PIN
ID20004925Medicare PIN
WAG8920757Medicare PIN
WAG8918708Medicare PIN
WA332255OtherLNI PROVIDER ID
WA2007776Medicaid
WAP00863780Medicare PIN
WAG8891920Medicare PIN
WAG8891919Medicare PIN