Provider Demographics
NPI:1386297505
Name:FOX WEST MEDICAL LTD
Entity type:Organization
Organization Name:FOX WEST MEDICAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-709-8643
Mailing Address - Street 1:1911 SW CAMPUS DR # 435
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6473
Mailing Address - Country:US
Mailing Address - Phone:253-709-8643
Mailing Address - Fax:
Practice Address - Street 1:101 2ND ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4902
Practice Address - Country:US
Practice Address - Phone:253-709-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty