Provider Demographics
NPI:1902841745
Name:FOX, PETER R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:R
Last Name:FOX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 W HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391-1242
Mailing Address - Country:US
Mailing Address - Phone:541-336-5181
Mailing Address - Fax:541-336-7614
Practice Address - Street 1:199 W HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391-1242
Practice Address - Country:US
Practice Address - Phone:541-336-5181
Practice Address - Fax:541-336-7614
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS16322Medicare UPIN