MEDICARE: CHARLIE W. FOX MD

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	207RG0100X	Gastroenterology Physician	12220341-1205	UT

General Provider Information

NPI Number	:	1992201909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLIE W. FOX MD

Provider Business Mailing Address
First Line	:	1187 E 3900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1201
Country	:	US
Telephone Number	:	801-944-3144
Fax Number	:	801-944-3186

Provider Business Practice Location Address
First Line	:	6360 S 3000 E STE 310
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6939
Country	:	US
Telephone Number	:	801-944-3144
Fax Number	:

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

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	07/01/2024

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Directions to “ CHARLIE W. FOX MD” Practice Location

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