Healthcare Provider Details

I. General information

NPI: 1770076317
Provider Name (Legal Business Name): SAMANTHA FOX AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA MUNZER AU.D.

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD STE 385A
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

615 S NEW BALLAS RD STE 385A
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-5850
  • Fax:
Mailing address:
  • Phone: 314-251-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2018019011
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: