Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 016321 | LA |
NPI | 1013943984 |
---|---|
Provider Name | Dr. Jack L Cox JR. |
First Address | Ruston, LA 71273-2048 |
Second Address | Ruston, LA 71270-3327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 12/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1337048 | (05) | LA |
B60753 | (02) | LA |