Provider Demographics
NPI:1265437990
Name:COX, MARK TAYLOR (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:TAYLOR
Last Name:COX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1445 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-9200
Mailing Address - Country:US
Mailing Address - Phone:660-829-0037
Mailing Address - Fax:
Practice Address - Street 1:3400 W 10TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2198
Practice Address - Country:US
Practice Address - Phone:660-827-1120
Practice Address - Fax:660-827-2756
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMO103838207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207869801Medicaid
MOF98870Medicare UPIN
MO207869801Medicaid