Provider Demographics
NPI:1629078571
Name:COX, BART
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:
Last Name:COX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:
Practice Address - Street 1:1101 MEDICAL ARTS AVE NE
Practice Address - Street 2:BUILDING 4, SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2706
Practice Address - Country:US
Practice Address - Phone:505-272-2273
Practice Address - Fax:505-272-2075
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28503-020207RC0000X
NMMD2010-0724207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI002240245Medicare PIN
WI31365300Medicaid
WI002260350Medicare PIN
WI002254475Medicare PIN
WIB52221Medicare UPIN
WI002246515Medicare PIN
WI002204130Medicare PIN