Provider Demographics
NPI:1124034566
Name:FOX, SHERRILL A (MD)
Entity Type:Individual
Prefix:
First Name:SHERRILL
Middle Name:A
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 E 2ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4338
Mailing Address - Country:US
Mailing Address - Phone:307-577-5100
Mailing Address - Fax:307-234-1201
Practice Address - Street 1:6500 E 2ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4338
Practice Address - Country:US
Practice Address - Phone:307-577-5100
Practice Address - Fax:307-234-1201
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5958A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY611665900OtherDEPT OF LABOR
WY314512OtherBC/BS
WY113011100Medicaid
WYP00325777Medicare PIN
WY611665900OtherDEPT OF LABOR
WYG94276Medicare UPIN