Provider Demographics
NPI:1225027709
Name:FOX, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15 ESCALON DR
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1339
Mailing Address - Country:US
Mailing Address - Phone:415-515-7773
Mailing Address - Fax:415-388-2829
Practice Address - Street 1:15 ESCALON DR
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1339
Practice Address - Country:US
Practice Address - Phone:415-515-7773
Practice Address - Fax:415-388-2829
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG31552207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G315520OtherBLUE SHIELD
CA00G315520Medicaid
CA00G315520OtherBLUE SHIELD
CA00G315520Medicaid