Provider Demographics
NPI:1104820513
Name:COX, IRA LEE III (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:LEE
Last Name:COX
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 VERONA TER
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:KS
Mailing Address - Zip Code:66208-1276
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19609 E 9TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056-3088
Practice Address - Country:US
Practice Address - Phone:816-796-1412
Practice Address - Fax:816-796-3398
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-141892085R0202X
MOR54552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203144814Medicaid
KS100200870DMedicaid
MO1104820513Medicaid
KS100200870CMedicaid
MOP00745614OtherRR MEDICARE
KS100200870BMedicaid
MO056B00002Medicare PIN
KS100200870BMedicaid
KSK67A00008Medicare PIN
MOP00745614OtherRR MEDICARE
MO1104820513Medicaid
KS100200870CMedicaid
MOK67000017Medicare PIN
KS104363Medicare PIN
MOJ965610BMedicare PIN
KSJ965610AMedicare PIN