Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 34005284F | OH |
Y | 207NS0135X | Procedural Dermatology | 34005284 | OH |
NPI | 1417971367 |
---|---|
Provider Name | Monte E Fox |
First Address | Canton, OH 44718-2978 |
Second Address | Canton, OH 44718-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 26/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0972514 | (05) | OH |
E53339 | (02) | OH |