Basic Information
| Provider Information | |||||||||
| NPI: | 1306837430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1357 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339021357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393320417 | ||||||||
| FaxNumber: | 2393349417 | ||||||||
| Practice Location | |||||||||
| Address1: | 4120 TAMIAMI TRL | ||||||||
| Address2: | SUITE E | ||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339529200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393320417 | ||||||||
| FaxNumber: | 9416292365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME80723 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 259533800 | 05 | FL | MEDICAID |