Provider Demographics
NPI:1942429741
Name:ROBERT A. FOX, MD, INC
Entity Type:Organization
Organization Name:ROBERT A. FOX, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-233-0056
Mailing Address - Street 1:2150 APPIAN WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2520
Mailing Address - Country:US
Mailing Address - Phone:510-233-0056
Mailing Address - Fax:510-233-0538
Practice Address - Street 1:2150 APPIAN WAY STE 100
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2520
Practice Address - Country:US
Practice Address - Phone:510-233-0056
Practice Address - Fax:510-233-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA196173700OtherDEPT OF LABOR PROVIDER #
CA00G258580Medicaid
CA021065OtherHILL PHYSICIANS VENDOR #
CA00G258580Medicare PIN
CA196173700OtherDEPT OF LABOR PROVIDER #