Provider Demographics
NPI:1740554666
Name:COX, DAVID BRYAN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRYAN
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 1:22301 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2619
Mailing Address - Country:US
Mailing Address - Phone:586-443-5588
Mailing Address - Fax:586-443-5538
Practice Address - Street 1:22301 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2619
Practice Address - Country:US
Practice Address - Phone:586-443-5588
Practice Address - Fax:586-443-5538
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301051774OtherLICENSE