Provider Demographics
NPI:1790822542
Name:COX, JENNIFER AMY (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:AMY
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 EAST 100 SOUTH
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1575
Mailing Address - Country:US
Mailing Address - Phone:801-521-2640
Mailing Address - Fax:801-363-6407
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:SUITE 400
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-521-2640
Practice Address - Fax:801-363-6407
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1854551205208000000X
UT185455-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$002Medicaid