Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 46691 | TN |
N | 111NI0900X | Internist | 46691 | TN |
Y | 208D00000X | General Practice Physician | 46691 | TN |
NPI | 1003057068 |
---|---|
Provider Name | Dr. Alan Cox |
First Address | Johnson City, TN 37604-1902 |
Second Address | Johnson City, TN 37604-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2009 |
Last Update Date | 30/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1522714 | (05) | TN |
P01302082 | RR MEDICARE (01) | TN |