Basic Information
| Provider Information | |||||||||
| NPI: | 1003853268 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 229 | ||||||||
| Address2: | |||||||||
| City: | WAKEFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028800229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017883929 | ||||||||
| FaxNumber: | 4017831872 | ||||||||
| Practice Location | |||||||||
| Address1: | 268 POST RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | WESTERLY | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028916600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016042530 | ||||||||
| FaxNumber: | 4016042560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD09837 | RI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0000X | RI9837 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00015916 | 01 | RI | RAILROAD MEDICARE | OTHER |