Organization
DIETHRA D. COX, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIETHRA D. COX M.D. (PRESIDENT)
(440) 205-0242
Entity
Organization
Contact information
Practice address
9485 MENTOR AVE, SUITE 203, MENTOR, OH 44060-4597
(440) 205-0242
Mailing address
9485 MENTOR AVE, SUITE 203, MENTOR, OH 44060-4597
(440) 205-0242
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-05-4360-C
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0702789
—
OH
Enumeration date
02/21/2007
Last updated
02/25/2011
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