Healthcare Provider Details

I. General information

NPI: 1447662705
Provider Name (Legal Business Name): JOHN M FOX DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 PHALEN BLVD
SAINT PAUL MN
55130-5302
US

IV. Provider business mailing address

435 PHALEN BLVD
SAINT PAUL MN
55130-5302
US

V. Phone/Fax

Practice location:
  • Phone: 651-636-9443
  • Fax: 651-265-7363
Mailing address:
  • Phone: 651-636-9443
  • Fax: 651-265-7363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number68571
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number68571
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: