Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | G36192 | CA |
NPI | 1053389254 |
---|---|
Provider Name | Dr. Michael Eliot Fox |
First Address | Orange, CA 92868-4312 |
Second Address | Orange, CA 92868-3855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 12/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1912919804 | NPI - TYPE 2 (01) | CA |
A46604 | (02) | CA |
W1514 | MEDICARE PTAN - TYPE 2 (01) | CA |