Healthcare Provider Details

I. General information

NPI: 1063697639
Provider Name (Legal Business Name): BRUCE FOX DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8505 FENTON ST SUITE 200
SILVER SPRING MD
20910-4497
US

IV. Provider business mailing address

8505 FENTON ST SUITE 200
SILVER SPRING MD
20910-4497
US

V. Phone/Fax

Practice location:
  • Phone: 301-589-7663
  • Fax: 301-589-3410
Mailing address:
  • Phone: 301-589-7663
  • Fax: 301-589-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number01336
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number01336
License Number StateMD

VIII. Authorized Official

Name: DR. BRUCE TODD FOX
Title or Position: PRESIDENT
Credential: DPM
Phone: 301-589-7663