Provider Demographics
NPI:1861846651
Name:COX, SUSAN (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:4808 WHISTLER DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5122
Mailing Address - Country:US
Mailing Address - Phone:239-580-8878
Mailing Address - Fax:
Practice Address - Street 1:4808 WHISTLER DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5122
Practice Address - Country:US
Practice Address - Phone:239-580-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99267176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife