Provider Demographics
NPI:1417923145
Name:FOX, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 VALE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3835
Mailing Address - Country:US
Mailing Address - Phone:510-233-0056
Mailing Address - Fax:510-233-0538
Practice Address - Street 1:2101 VALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3835
Practice Address - Country:US
Practice Address - Phone:510-233-0056
Practice Address - Fax:510-233-0538
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG258582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA021065OtherHILL PHYSICIANS VENDOR #
CA00G258580Medicaid
CA196173700OtherDEPT OF LABOR PROVIDER #
CA021065OtherHILL PHYSICIANS VENDOR #
CA00G258580Medicaid