Provider Demographics
NPI:1609960566
Name:FOX, GLENNON JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENNON
Middle Name:JOSEPH
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:777 SOUTH NEW BALLAS RD
Mailing Address - Street 2:231E
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8747
Mailing Address - Country:US
Mailing Address - Phone:314-414-2273
Mailing Address - Fax:314-414-2273
Practice Address - Street 1:777 SOUTH NEW BALLAS RD
Practice Address - Street 2:231E
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8747
Practice Address - Country:US
Practice Address - Phone:314-414-2273
Practice Address - Fax:314-414-2273
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-11-16
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Provider Licenses
StateLicense IDTaxonomies
MORIH06207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A12930Medicare UPIN