Provider Demographics
NPI:1427404672
Name:COX, JAY SHELTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:SHELTON
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 185
Mailing Address - Street 2:
Mailing Address - City:DEPOE BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97341-0185
Mailing Address - Country:US
Mailing Address - Phone:541-764-2113
Mailing Address - Fax:
Practice Address - Street 1:80 RAVEN LANE
Practice Address - Street 2:
Practice Address - City:DEPOE BAY
Practice Address - State:OR
Practice Address - Zip Code:97341-0185
Practice Address - Country:US
Practice Address - Phone:541-764-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA18845207X00000X
PAMD044537E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery