Provider Demographics
NPI:1861472011
Name:COX, FRED ARTHUR (DO)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:ARTHUR
Last Name:COX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-9000
Mailing Address - Country:US
Mailing Address - Phone:719-553-2204
Mailing Address - Fax:719-553-2222
Practice Address - Street 1:3676 PARKER BLVD STE 260
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2213
Practice Address - Country:US
Practice Address - Phone:719-553-2204
Practice Address - Fax:719-553-2222
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB96868Medicare UPIN