Healthcare Provider Details

I. General information

NPI: 1770226813
Provider Name (Legal Business Name): JONATHON FOX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JONATHON SCHILLER

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 CHARDONNAY AVE STE A
PROSSER WA
99350-9515
US

IV. Provider business mailing address

1671 JERICHO RD
RICHLAND WA
99352-8687
US

V. Phone/Fax

Practice location:
  • Phone: 509-786-1576
  • Fax:
Mailing address:
  • Phone: 813-323-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.OP.61688028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: