Provider Demographics
NPI:1306919725
Name:FOX, EARL ROSS (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:ROSS
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 PACIFIC AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418
Mailing Address - Country:US
Mailing Address - Phone:253-472-9850
Mailing Address - Fax:253-472-6479
Practice Address - Street 1:3716 PACIFIC AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418
Practice Address - Country:US
Practice Address - Phone:253-472-9850
Practice Address - Fax:253-472-6479
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD0002094208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016468Medicaid
WA8806245Medicare ID - Type Unspecified
E00042Medicare UPIN