Provider Demographics
NPI:1821215997
Name:COX, WAYNE ELDON (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ELDON
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:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0918
Mailing Address - Country:US
Mailing Address - Phone:435-637-2970
Mailing Address - Fax:435-637-9158
Practice Address - Street 1:945 W HOSPITAL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4214
Practice Address - Country:US
Practice Address - Phone:435-637-2970
Practice Address - Fax:435-637-9158
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT80-165115-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1156268OtherUMWA
UTDO7335Medicare UPIN
UT000001101Medicare ID - Type Unspecified