Healthcare Provider Details

I. General information

NPI: 1447221932
Provider Name (Legal Business Name): JON R FOX PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10798 W OVERLAND RD
BOISE ID
83709
US

IV. Provider business mailing address

10798 W OVERLAND RD
BOISE ID
83709-1329
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-3368
  • Fax: 208-322-4691
Mailing address:
  • Phone: 208-377-3368
  • Fax: 208-322-4691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-1083
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1083
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: