Healthcare Provider Details

I. General information

NPI: 1043499106
Provider Name (Legal Business Name): ROBERT E FOX JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MCCRACKEN
CHOUTEAU OK
74337
US

IV. Provider business mailing address

PO BOX 729
CHOUTEAU OK
74337-0729
US

V. Phone/Fax

Practice location:
  • Phone: 918-476-5111
  • Fax:
Mailing address:
  • Phone: 918-476-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT E FOX
Title or Position: OWNER
Credential: DO
Phone: 918-476-5111