Provider Demographics
NPI:1740331263
Name:FOX, GREGORY M (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:639 S WALKER ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2123
Mailing Address - Country:US
Mailing Address - Phone:812-333-4000
Mailing Address - Fax:812-333-0611
Practice Address - Street 1:639 S WALKER ST
Practice Address - Street 2:SUITE E
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2123
Practice Address - Country:US
Practice Address - Phone:812-333-4000
Practice Address - Fax:812-333-0611
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2015-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01044833A207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
545620FMedicare ID - Type Unspecified
F39776Medicare UPIN