Provider Demographics
NPI:1487680716
Name:LOX, DENNIS MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MARSHALL
Last Name:LOX
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 1:2030 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3117
Mailing Address - Country:US
Mailing Address - Phone:727-462-5582
Mailing Address - Fax:727-462-5583
Practice Address - Street 1:2030 DREW ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3117
Practice Address - Country:US
Practice Address - Phone:727-462-5582
Practice Address - Fax:727-462-5583
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC18577Medicare UPIN
FL10612Medicare ID - Type Unspecified