Provider Demographics
NPI:1801806039
Name:COX, ELIZABETH D (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:COX
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:209 CROSSROADS PL
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6545
Mailing Address - Country:US
Mailing Address - Phone:618-241-7207
Mailing Address - Fax:618-241-7210
Practice Address - Street 1:209 CROSSROADS PL
Practice Address - Street 2:SUITE 140
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6545
Practice Address - Country:US
Practice Address - Phone:618-241-7207
Practice Address - Fax:618-241-7210
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-11-08
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Provider Licenses
StateLicense IDTaxonomies
IL036-115578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115578Medicaid
IL413202OtherBCBS
IL036115578Medicaid