Provider Demographics
NPI:1932267945
Name:FOX, GARY RICHARD
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:RICHARD
Last Name:FOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 S RAY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3832
Mailing Address - Country:US
Mailing Address - Phone:509-535-7434
Mailing Address - Fax:509-536-4744
Practice Address - Street 1:1723 S RAY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-3832
Practice Address - Country:US
Practice Address - Phone:509-535-7434
Practice Address - Fax:509-536-4744
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000044122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5021027Medicaid
WA91062OtherWDS DELTA DENTAL