Healthcare Provider Details

I. General information

NPI: 1346419686
Provider Name (Legal Business Name): ROBERT JASON FOX DOM, L.AC, APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 N DR MARTIN LUTHER KING JR DR FL 2
MILWAUKEE WI
53212-1484
US

IV. Provider business mailing address

3338 N DR MARTIN LUTHER KING JR DR
MILWAUKEE WI
53212-1484
US

V. Phone/Fax

Practice location:
  • Phone: 414-640-5433
  • Fax: 414-502-0192
Mailing address:
  • Phone: 414-640-5433
  • Fax: 414-502-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4476-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4476-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4476-33
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number383-055
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: