Healthcare Provider Details

I. General information

NPI: 1699688085
Provider Name (Legal Business Name): EVAN FOX PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER DR
MATTOON IL
61938-4644
US

IV. Provider business mailing address

6 QUAIL RUN PL
CHARLESTON IL
61920-4408
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-2525
  • Fax:
Mailing address:
  • Phone: 618-554-5383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: