Provider Demographics
NPI:1225789118
Name:FOX, DAVID LEWIS
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEWIS
Last Name:FOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 NE COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7752
Mailing Address - Country:US
Mailing Address - Phone:541-322-7500
Mailing Address - Fax:
Practice Address - Street 1:51340 HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9871
Practice Address - Country:US
Practice Address - Phone:541-322-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator