Provider Demographics
NPI:1336148089
Name:COX FLOREZ, FAWN (DC)
Entity type:Individual
Prefix:DR
First Name:FAWN
Middle Name:
Last Name:COX FLOREZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 ROBERTS CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-2023
Mailing Address - Country:US
Mailing Address - Phone:817-731-7004
Mailing Address - Fax:817-731-6999
Practice Address - Street 1:1711 ROBERTS CUT OFF RD
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-2023
Practice Address - Country:US
Practice Address - Phone:817-731-7004
Practice Address - Fax:817-731-6999
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCO6054051Medicaid
TXU60633Medicare UPIN
TXCO6054051Medicaid