Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 9939 | AZ |
NPI | 1427416353 |
---|---|
Provider Name | Glade Cox |
First Address | Brooklyn, NY 11216-4141 |
Second Address | Brooklyn, NY 11220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2016 |
Last Update Date | 16/05/2018 |