Provider Demographics
NPI:1801848221
Name:COX, KIM LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LEON
Last Name:COX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:777 HOSPITAL WAY
Mailing Address - Street 2:BLDG A SUITE 300
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5175
Mailing Address - Country:US
Mailing Address - Phone:208-232-8792
Mailing Address - Fax:208-232-8793
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:BLDG A SUITE 300
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5175
Practice Address - Country:US
Practice Address - Phone:208-232-8792
Practice Address - Fax:208-232-8793
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM5779207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003643500Medicaid
ID160043915OtherRAILROAD MEDICARE
ID000010001682OtherREGENCE-BLUE SHIELD OF ID
ID76954OtherBLUE CROSS OF IDAHO
ID003643500Medicaid
ID160043915OtherRAILROAD MEDICARE