Provider Demographics
NPI:1447214663
Name:COX, WILLIAM GARY (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GARY
Last Name:COX
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PINERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-9756
Mailing Address - Country:US
Mailing Address - Phone:864-231-0130
Mailing Address - Fax:
Practice Address - Street 1:126 PINERIDGE DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-9756
Practice Address - Country:US
Practice Address - Phone:864-231-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0185Medicaid
SCP00294106Medicare ID - Type UnspecifiedRAILROAD MEDICARE