Organization
FOX RIDGE MEDICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY SCOTT TOMLIN MD (PRACTICE OWNER)
(815) 861-5543
Entity
Organization
Contact information
Practice address
3633 MUNICIPAL DR, MCHENRY, IL 60050
(815) 861-5543
Mailing address
3633 MUNICIPAL DR, MCHENRY, IL 60050-5434
(779) 244-3072
(815) 331-8389
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036.092485
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F100494732
PTAN
—
Enumeration date
06/25/2018
Last updated
08/28/2018
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