MEDICARE: DR. RICHARD FREDERICK 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	2085R0202X	Diagnostic Radiology Physician	1018330B	IN

General Provider Information

NPI Number	:	1376789420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD FREDERICK FOX M.D.

Provider Business Mailing Address
First Line	:	6226 DEVILS HOLLOW RD.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814
Country	:	US
Telephone Number	:	260-672-8417
Fax Number	:	260-672-8262

Provider Business Practice Location Address
First Line	:	6226 DEVILS HOLLOW RD.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814
Country	:	US
Telephone Number	:	260-672-8417
Fax Number	:	260-672-8262

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

Provider Enumeration Date	:	12/19/2008
Last Update Date	:	12/19/2008

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