Individual
MR. BENJMIN MICHAEL FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 UNIVERSITY PLZ # MS 7000, CAPE GIRARDEAU, MO 63701-4710
(573) 999-6217
Mailing address
1966 DELWIN ST APT 4, CAPE GIRARDEAU, MO 63701-2470
(573) 999-6217
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2011040138
MO
Other
Enumeration date
11/20/2007
Last updated
02/13/2017
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