Healthcare Provider Details

I. General information

NPI: 1043210701
Provider Name (Legal Business Name): SCOTT W MOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N RANDALL RD
ELGIN IL
60123-7876
US

IV. Provider business mailing address

1550 N RANDALL RD
ELGIN IL
60123-7876
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-9491
  • Fax: 815-381-7498
Mailing address:
  • Phone: 815-398-9491
  • Fax: 815-381-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-070708
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: