Provider Demographics
NPI:1396779930
Name:FOX, KURTIS H (MD)
Entity type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:H
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-1199
Mailing Address - Country:US
Mailing Address - Phone:530-346-8397
Mailing Address - Fax:
Practice Address - Street 1:101 W. GRASS VALLEY ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713
Practice Address - Country:US
Practice Address - Phone:530-346-2281
Practice Address - Fax:530-346-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30728207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307280OtherMEDICARE PTAN
CAA26208Medicare UPIN