Basic Information
| Provider Information | |||||||||
| NPI: | 1366613473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK W FOX MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 E 21ST ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053224825 | ||||||||
| FaxNumber: | 6053224826 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 E 21ST ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053224825 | ||||||||
| FaxNumber: | 6053224826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 07/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | FOX | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6053224825 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 63D15FO | 01 | SD | BLUE SHIELD OF MN | OTHER |