Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 907 | SC |
NPI | 1255383204 |
---|---|
Provider Name | Marcus T Cox |
First Address | Greenville, SC 29605-4255 |
Second Address | Greenville, SC 29605-4255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 17/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0449PA | (05) | SC |
P00329302 | RAILROAD MEDICARE (01) | SC |