MEDICARE: JOHN A. FOX M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XP3100X	Pediatric Orthopaedic Surgery Physician	0101226366	VA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200001150	OTHER	VA	MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	311610834	OTHER	VA	VHN
3	006402500	OTHER	VA	VA. PREMIER
4	09-00933	OTHER	VA	UHC
5	MD.206342	OTHER	LA	LOUISIANA STATE BOARD OF MEDICAL EXAMINERS - MEDICINE AND SURGERY
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	279227	OTHER	VA	ALLIANCE/MDIPA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7263169015	OTHER	VA	CIGNA
10	311610834	OTHER	VA	TRICARE
11	5485178	OTHER	VA	AETNA
12	615723	OTHER	VA	NC PPO
13	381727	OTHER	VA	ANTHEM BCBS
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	27603	OTHER	VA	OPTIMA/SENTARA HEALTH
16	279227	OTHER	VA	MAMSI/OPTIMUM CHOICE
17	311610834	OTHER	VA	BEECH STREET

NPI Number	:	1164438099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A. FOX M.D.

Provider Business Mailing Address
First Line	:	1202 LOUISIANA AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-3910
Country	:	US
Telephone Number	:	318-212-8951
Fax Number	:	318-212-6752

Provider Business Practice Location Address
First Line	:	7925 YOUREE DR STE 200
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-5134
Country	:	US
Telephone Number	:	318-212-3610
Fax Number	:	318-212-3709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	12/10/2018