Provider Demographics
NPI:1588621742
Name:FOX, CLINTON WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:WADE
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 1:2920 E MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4831
Mailing Address - Country:US
Mailing Address - Phone:501-203-0123
Mailing Address - Fax:501-500-6391
Practice Address - Street 1:2920 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4831
Practice Address - Country:US
Practice Address - Phone:501-203-0123
Practice Address - Fax:501-500-6391
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2799207Q00000X, 207QS0010X
ARE2799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143638001Medicaid
AR143638001Medicaid
ARP00447904OtherMEDICARE RAILROAD
AR5L781F336OtherMEDICARE ID TYPE UNSPEFIE