Individual
CHARLES RICHARD FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
520 E 6TH ST, ODESSA, TX 79761-4527
(432) 334-8088
(432) 580-7202
Mailing address
PO BOX 1226, ODESSA, TX 79760-1226
(432) 334-8088
(432) 580-7202
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
224868
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002676703
—
TX
01
—
002676704
MEDICAID CSHCN
TX
01
—
8963UC
BCBS
TX
Enumeration date
08/19/2005
Last updated
10/03/2012
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