Provider Demographics
NPI:1295915353
Name:COX, STEPHEN TROY (PAC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:TROY
Last Name:COX
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 NORTH ALVERNON WAY
Mailing Address - Street 2:SPECIALISTS IN DERMATOLOGY PLLC
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-382-3330
Mailing Address - Fax:520-382-3340
Practice Address - Street 1:2732 NORTH ALVERNON WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-382-3330
Practice Address - Fax:520-382-3340
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3695363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ282594Medicaid