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NPI Code Detail

MEDICARE: DR. GARY FOX M.D.

MEDICARE: DR. GARY FOX M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35065547OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104822287
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY FOX M.D.
Provider Business Mailing Address
First Line : 1400 E 2ND ST
Second Line : DEFIANCE CLINIC, SKIN CARE
City : DEFIANCE
State : OH
Zip : 43512-2440
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E 2ND ST
Second Line :
City : DEFIANCE
State : OH
Zip : 43512-2440
Country : US
Telephone Number : 419-783-3264
Fax Number : 419-783-3389
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 01/19/2008

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Directions to “ DR. GARY FOX M.D.” Practice Location

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