MEDICARE: DR. MATTHEW H FOX DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15402	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942488812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW H FOX DMD

Provider Business Mailing Address
First Line	:	10690 S US HIGHWAY 1 STE A
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-6411
Country	:	US
Telephone Number	:	772-335-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	10690 S US HIGHWAY 1 STE A
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-6411
Country	:	US
Telephone Number	:	772-335-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	02/04/2008

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