Healthcare Provider Details

I. General information

NPI: 1093989816
Provider Name (Legal Business Name): SANDRA K. FOX, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 N DETROIT ST
XENIA OH
45385-1928
US

IV. Provider business mailing address

1063 N DETROIT ST
XENIA OH
45385-1928
US

V. Phone/Fax

Practice location:
  • Phone: 937-376-2002
  • Fax: 937-376-4042
Mailing address:
  • Phone: 937-376-2002
  • Fax: 937-376-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36002599F
License Number StateOH

VIII. Authorized Official

Name: SANDRA K FOX
Title or Position: D.P.M.
Credential: OWNER
Phone: 937-376-2002