Provider Demographics
NPI:1851338941
Name:COX, CONRAD A (MD)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:A
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 1:5750 DOWNEY AVE STE 303
Mailing Address - Street 2:ATTENTION: ANTOINETTE M. COX
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1477
Mailing Address - Country:US
Mailing Address - Phone:562-461-8584
Mailing Address - Fax:562-529-7880
Practice Address - Street 1:5750 DOWNEY AVE STE 303
Practice Address - Street 2:ATTENTION: ANTOINETTE M. COX
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1477
Practice Address - Country:US
Practice Address - Phone:562-461-8584
Practice Address - Fax:562-529-7880
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG65723207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G657230Medicaid
P00361829OtherRAILROAD
056980OtherHEALTH NET ID #
110060920OtherRAILROAD
00G65723OtherBLUE SHIELD ID #
CAWG65723OMedicare PIN
P00361829OtherRAILROAD
056980OtherHEALTH NET ID #
E08472Medicare UPIN