Provider Demographics
NPI:1750975389
Name:COX JR, THOMAS D
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:COX JR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-0503
Mailing Address - Country:US
Mailing Address - Phone:304-575-7315
Mailing Address - Fax:
Practice Address - Street 1:402 WILLAPA LN
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:WV
Practice Address - Zip Code:25989-9641
Practice Address - Country:US
Practice Address - Phone:304-575-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker