Provider Demographics
NPI:1457336943
Name:FOX, RICHARD LEONARD (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEONARD
Last Name:FOX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2902
Mailing Address - Country:US
Mailing Address - Phone:954-721-4300
Mailing Address - Fax:954-721-8080
Practice Address - Street 1:7171 N UNIVERSITY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2902
Practice Address - Country:US
Practice Address - Phone:954-721-4300
Practice Address - Fax:954-721-8080
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279436OtherAVMED
FL01977OtherBC/BS FLORIDA
FL261938500Medicaid
FL279436OtherAVMED
FLG69673Medicare UPIN