Provider Demographics
NPI:1295818474
Name:FOX, RICHARD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4743 ARAPAHOE AVE
Mailing Address - Street 2:#102
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1113
Mailing Address - Country:US
Mailing Address - Phone:303-449-3642
Mailing Address - Fax:303-440-7298
Practice Address - Street 1:4743 ARAPAHOE AVE
Practice Address - Street 2:#102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1113
Practice Address - Country:US
Practice Address - Phone:303-449-3642
Practice Address - Fax:303-440-7298
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO40751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FOF60580OtherBLUE CROSS BLUE SHIELD
CO73459879Medicaid
FOF60580OtherBLUE CROSS BLUE SHIELD
COC810139Medicare PIN