Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 11-747 | TX |
NPI | 1033212444 |
---|---|
Provider Name | Dr. Lee Thomas Fox |
First Address | Conroe, TX 77304-3500 |
Second Address | Conroe, TX 77304-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/07/2007 |