Provider Demographics
NPI:1548221328
Name:FOX, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
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 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6200
Mailing Address - Fax:641-754-6245
Practice Address - Street 1:1200 1ST AVE E
Practice Address - Street 2:SUITE A
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4342
Practice Address - Country:US
Practice Address - Phone:800-542-7956
Practice Address - Fax:641-754-6245
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38105207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06170OtherWELLMARK BLUE CROSS BLUE SHIELD
IA0061705Medicaid
IA0061705Medicaid
IA06170003Medicare PIN
OH31524700006OtherMEDICAL MUTUAL
OH0000000377497OtherBLUE CROSS & BLUE SHIELD
OH203258464OtherTRICARE
OHF87291Medicare UPIN
IA0061705Medicaid
OH7922198OtherAETNA
OH7922198OtherAETNA