Basic Information
| Provider Information | |||||||||
| NPI: | 1750355236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | WARREN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 E 21ST ST | ||||||||
| Address2: | STE 220 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053224825 | ||||||||
| FaxNumber: | 6053224826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 01/15/2009 | ||||||||
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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 | 207T00000X | 4319 | SD | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 320715300 | 05 | MN | MEDICAID | 4319 | 01 | SD | DAKOTACARE | OTHER | 57105AU02 | 01 | SD | WPS TRICARE | OTHER | 63D16FO | 01 | MN | CC SYSTEMS/BLUE PLUS FOR DATES PRIOR TO 9-1-07 | OTHER | 1750355236 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 0600325 | 01 | SD | MEDICA | OTHER | 231714 | 01 | SD | MIDLANDS CHOICE | OTHER | 46L94FO | 01 | MN | CC SYSTEMS/BLUE PLUS | OTHER | C83121001265 | 01 | PREFERRED ONE | OTHER | 6100533 | 05 | SD | MEDICAID | 10025562500 | 05 | NE | MEDICAID | 4992870 | 01 | SD | BLUE CROSS | OTHER | HP13310 | 01 | SD | HEALTHPARTNERS | OTHER |