Provider Demographics
NPI:1306837430
Name:COX, LAURA M (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-332-0417
Mailing Address - Fax:239-334-9417
Practice Address - Street 1:4120 TAMIAMI TRL
Practice Address - Street 2:SUITE E
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9200
Practice Address - Country:US
Practice Address - Phone:239-332-0417
Practice Address - Fax:941-629-2365
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259533800Medicaid
FL35947ZMedicare ID - Type Unspecified
FLH21734Medicare UPIN