Healthcare Provider Details

I. General information

NPI: 1134300650
Provider Name (Legal Business Name): KEITH C FOX DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 RIVER DR
COLUMBIA SC
29201-1604
US

IV. Provider business mailing address

2734 RIVER DR
COLUMBIA SC
29201-1604
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-7701
  • Fax: 803-733-3444
Mailing address:
  • Phone: 803-256-7701
  • Fax: 803-733-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateSC

VIII. Authorized Official

Name: KEITH C FOX
Title or Position: PRESIDENT
Credential: DPM
Phone: 803-256-7701