Basic Information
| Provider Information | |||||||||
| NPI: | 1912069758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DENNIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1839 S EL DORADO ST | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952062025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094630872 | ||||||||
| FaxNumber: | 2094664446 | ||||||||
| Practice Location | |||||||||
| Address1: | 1839 S EL DORADO ST | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952062025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094630872 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 10/15/2019 | ||||||||
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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 | 207QA0401X | G53561 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207Q00000X | G53561 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.