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General NPI Number Information
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NPI Number | 1700077542
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Entity Type | Organization
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Legal Business Name | TRI COUNTY DERMATOLOGY INC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 4240 MUNSON ST NW SUITE C
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City | CANTON
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State | OH
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Zip | 44718-2981
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Country | US
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Telephone | 330-492-2327
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Fax | 330-492-0953
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Provider Business Mailing Address
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Address Line | 4240 MUNSON ST NW SUITE C
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City | CANTON
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State | OH
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Zip | 44718-2981
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Country | US
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Telephone | 330-492-2327
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Fax | 330-492-0953
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. MONTE E FOX
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Credential | D.O.
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Telephone | 330-492-2327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 34005284
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License Number State | OH
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