Provider Demographics
NPI:1881891240
Name:FOX, SAMUEL DEAN (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DEAN
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
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 9727
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-9727
Mailing Address - Country:US
Mailing Address - Phone:309-886-9172
Mailing Address - Fax:
Practice Address - Street 1:3525 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1324
Practice Address - Country:US
Practice Address - Phone:309-886-9172
Practice Address - Fax:309-509-4045
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology