Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G53561 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | G53561 | CA |
NPI | 1912069758 |
---|---|
Provider Name | Dr. Michael Dennis Fox |
First Address | Stockton, CA 95206-2025 |
Second Address | Stockton, CA 95206-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 15/10/2019 |