MEDICARE: DR. ROBERT A. 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
1	208D00000X	General Practice Physician	G32218	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G32219	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1215147533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A. FOX M.D.

Provider Business Mailing Address
First Line	:	3534 SANTA CARLOTTA ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91214-1115
Country	:	US
Telephone Number	:	818-957-1652
Fax Number	:	818-957-4672

Provider Business Practice Location Address
First Line	:	3534 SANTA CARLOTTA ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91214-1115
Country	:	US
Telephone Number	:	818-957-1652
Fax Number	:	818-957-4672

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. ROBERT A. FOX M.D.” Practice Location

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