Provider Demographics
NPI:1447220843
Name:FOX, MARK DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DOUGLAS
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1234 N NOTRE DAME AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1404
Mailing Address - Country:US
Mailing Address - Phone:574-631-1337
Mailing Address - Fax:574-631-8932
Practice Address - Street 1:1234 N NOTRE DAME AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1404
Practice Address - Country:US
Practice Address - Phone:574-631-1337
Practice Address - Fax:574-631-8932
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23209207R00000X, 208000000X
IN01075847A207R00000X, 208000000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics