Healthcare Provider Details

I. General information

NPI: 1154627941
Provider Name (Legal Business Name): CLEMENT WADE FOX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W. CAPITOL
LITTLE ROCK AR
72201
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 501-379-4664
  • Fax: 501-379-4663
Mailing address:
  • Phone: 318-966-6500
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE-2558
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberE-2558
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number019424
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: