Provider Demographics
NPI:1699814319
Name:FOX, PAUL A
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:FOX
Suffix:
Gender:M
Credentials:
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 3559
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-3559
Mailing Address - Country:US
Mailing Address - Phone:720-635-0361
Mailing Address - Fax:719-487-3253
Practice Address - Street 1:17577 LEISURE LAKE DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7954
Practice Address - Country:US
Practice Address - Phone:720-635-0361
Practice Address - Fax:719-487-3253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA. 0001060246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant