Active NPI
Gary Fox, M.D.
- Family Medicine Physician
- Defiance, OH
National Provider Identifier
1104822287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35065547
- Practice address
- 1400 E 2ND St
Defiance, OH 43512-2440 - Phone
- (419) 783-3264
- Fax
- (419) 783-3389
- NPI assigned
- Jun 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35065547 | OH | Primary |
Addresses
Primary practice location
1400 E 2ND St
Defiance, OH 43512-2440
Mailing address
1400 E 2ND St
Defiance Clinic, Skin Care
Defiance, OH 43512-2440
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0965719 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35065547 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fauster Cameron Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Defiance, OH
- NPI 1649253964
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200700800000",
"number": "1104822287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 E 2ND ST",
"address_2": "DEFIANCE CLINIC, SKIN CARE",
"city": "DEFIANCE",
"state": "OH",
"postal_code": "435122440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 E 2ND ST",
"city": "DEFIANCE",
"state": "OH",
"postal_code": "435122440",
"telephone_number": "419-783-3264",
"fax_number": "419-783-3389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOX",
"first_name": "GARY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-23",
"last_updated": "2008-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "35065547",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0965719",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Defiance, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.