Provider Demographics
NPI:1417971367
Name:FOX, MONTE E (DO)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:E
Last Name:FOX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29111 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4005
Mailing Address - Country:US
Mailing Address - Phone:330-492-2327
Mailing Address - Fax:330-492-0953
Practice Address - Street 1:4240 MUNSON ST NW STE C
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2978
Practice Address - Country:US
Practice Address - Phone:330-492-2327
Practice Address - Fax:330-492-0953
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005284F207N00000X
OH34005284207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0972514Medicaid
OH0972514Medicaid
OH0761841Medicare PIN