Organization
SURGICAL WEIGHT LOSS CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL ROSS FOX MD (OWNER & SURGEON)
(253) 472-9850
Entity
Organization
Contact information
Practice address
3716 PACIFIC AVE, SUITE B, TACOMA, WA 98418-7836
(253) 472-9850
Mailing address
3716 PACIFIC AVE, SUITE B, TACOMA, WA 98418-7836
(253) 472-9850
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
MD00005293
WA
261QM2500X
Medical Specialty Clinic/Center
MD0002094
WA
261QM2500X
Medical Specialty Clinic/Center
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1016468
DSHS FOR EARL ROSS FOX
WA
01
—
1306919725
NPI FOR EARL ROSS FOX
WA
01
—
1942363353
NPI FOR SAMUEL ROSS FOX
WA
05
—
7124175
—
WA
01
—
8178618
DSHS FOR SAMUEL ROSS FOX
WA
Enumeration date
03/26/2007
Last updated
07/21/2022
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