Provider Demographics
NPI:1962842815
Name:COX, CARLY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:ANNE
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3080 E GENTRY WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3013
Mailing Address - Country:US
Mailing Address - Phone:208-384-9022
Mailing Address - Fax:208-388-1683
Practice Address - Street 1:3080 E GENTRY WAY STE 210
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-384-9022
Practice Address - Fax:208-388-1683
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDM-14044207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program