Provider Demographics
NPI:1477655827
Name:COX, RANDY J (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:J
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 1:2315 MAYFAIR DRIVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301
Mailing Address - Country:US
Mailing Address - Phone:270-926-6864
Mailing Address - Fax:270-685-4717
Practice Address - Street 1:2315 MAYFAIR DRIVE
Practice Address - Street 2:SUITE 9
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-926-6864
Practice Address - Fax:270-685-4717
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY212052084N0400X
IN0102702432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64212053Medicaid
IN100373420AMedicaid
KY1319701Medicare ID - Type Unspecified
C69365Medicare UPIN
KY64212053Medicaid