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General NPI Number Information
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NPI Number | 1639748882
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Entity Type | Organization
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Legal Business Name | FOX MEDICAL CENTER
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 4620 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4237
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Country | US
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Telephone | 253-368-7822
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Fax | 773-304-1911
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Provider Business Mailing Address
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Address Line | 5721 S HUSON ST
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City | TACOMA
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State | WA
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Zip | 98409-1201
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Country | US
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Telephone | 773-263-8591
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Fax | 773-304-1911
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN LEE FOX
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Credential | DO
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Telephone | 773-263-8591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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