Provider Demographics
NPI:1437339454
Name:ADCOX, BRENT M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:M
Last Name:ADCOX
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 1:4201 BARTLETT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7015
Mailing Address - Country:US
Mailing Address - Phone:907-235-0310
Mailing Address - Fax:907-235-0310
Practice Address - Street 1:4201 BARTLETT ST STE 201
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7015
Practice Address - Country:US
Practice Address - Phone:907-235-0310
Practice Address - Fax:907-235-0276
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9771207XS0117X
AK7215207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2023301-01Medicaid
TX2023301-01Medicaid