Provider Demographics
NPI:1952307985
Name:COX, BRIAN A (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
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:PO BOX 80018
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91716-8018
Mailing Address - Country:US
Mailing Address - Phone:626-449-4859
Mailing Address - Fax:626-403-0321
Practice Address - Street 1:950 S ARROYO PKWY STE 310
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3930
Practice Address - Country:US
Practice Address - Phone:626-449-4859
Practice Address - Fax:626-403-0311
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2022-07-10
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
CA80824208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G808240OtherBLUE SHIELD PROVIDER
CA00G808240Medicaid
CA00G808240Medicaid