Provider Demographics
NPI:1689716219
Name:FOX, AUDRALAN (MD)
Entity Type:Individual
Prefix:
First Name:AUDRALAN
Middle Name:
Last Name:FOX
Suffix:
Gender:F
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:PO BOX 108809
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8809
Mailing Address - Country:US
Mailing Address - Phone:405-622-3699
Mailing Address - Fax:405-585-0730
Practice Address - Street 1:5472 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-5524
Practice Address - Country:US
Practice Address - Phone:904-421-2119
Practice Address - Fax:405-271-2797
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200220650BMedicaid
OK200220650BMedicaid