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NPI Code Detail

MEDICARE: SAMUEL DEAN FOX M.D.

MEDICARE: SAMUEL DEAN 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
1207V00000XObstetrics & Gynecology Physician4301090776MI

General Provider Information

NPI Number : 1881891240
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL DEAN FOX M.D.
Provider Business Mailing Address
First Line : PO BOX 9727
Second Line :
City : PEORIA
State : IL
Zip : 61612-9727
Country : US
Telephone Number : 309-886-9172
Fax Number :
Provider Business Practice Location Address
First Line : 3525 N UNIVERSITY ST
Second Line :
City : PEORIA
State : IL
Zip : 61604-1324
Country : US
Telephone Number : 309-886-9172
Fax Number : 309-509-4045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2007
Last Update Date : 07/10/2025

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