Provider Demographics
NPI:1609807593
Name:FOX, MACY L (DO)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:L
Last Name:FOX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9801 FRONTIER AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-5200
Mailing Address - Country:US
Mailing Address - Phone:425-831-1120
Mailing Address - Fax:425-831-1142
Practice Address - Street 1:7726 CENTER BLVD SE
Practice Address - Street 2:STE 230
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-8748
Practice Address - Country:US
Practice Address - Phone:425-831-1120
Practice Address - Fax:425-831-1142
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001959207QA0505X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG04863Medicare UPIN
G8931045Medicare PIN
WAG04863Medicare UPIN