Provider Demographics
NPI:1013177468
Name:KENT WALTER COX MD PS
Entity Type:Organization
Organization Name:KENT WALTER COX MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-532-0072
Mailing Address - Street 1:5448 WHITE MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5739
Mailing Address - Country:US
Mailing Address - Phone:928-532-0072
Mailing Address - Fax:928-532-0078
Practice Address - Street 1:5448 WHITE MOUNTAIN BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5739
Practice Address - Country:US
Practice Address - Phone:928-532-0072
Practice Address - Fax:928-532-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24584207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ431057Medicaid
AZA04317Medicare UPIN
AZZ23181Medicare PIN