Provider Demographics
NPI:1366422651
Name:FOX, COLLEEN L (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:L
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:505 NE 87TH AVENUE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4897
Mailing Address - Country:US
Mailing Address - Phone:360-514-1060
Mailing Address - Fax:360-514-1065
Practice Address - Street 1:505 NE 87TH AVENUE
Practice Address - Street 2:SUITE 160
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4897
Practice Address - Country:US
Practice Address - Phone:360-514-1060
Practice Address - Fax:360-514-1065
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00036005207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8226615Medicaid
WA8226615Medicaid
WAG8886639Medicare PIN