Provider Demographics
NPI:1043499106
Name:ROBERT E FOX JR
Entity Type:Organization
Organization Name:ROBERT E FOX JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-476-5111
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337-0729
Mailing Address - Country:US
Mailing Address - Phone:918-476-5111
Mailing Address - Fax:
Practice Address - Street 1:101 N MCCRACKEN
Practice Address - Street 2:
Practice Address - City:CHOUTEAU
Practice Address - State:OK
Practice Address - Zip Code:74337
Practice Address - Country:US
Practice Address - Phone:918-476-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522184Medicare PIN