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General NPI Number Information
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NPI Number | 1164438099
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Entity Type | Individual
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Provider Name | JOHN A. FOX M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 7925 YOUREE DR STE 200
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City | SHREVEPORT
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State | LA
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Zip | 71105-5134
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Country | US
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Telephone | 318-212-3610
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Fax | 318-212-3709
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Provider Business Mailing Address
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Address Line | 1202 LOUISIANA AVE
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City | SHREVEPORT
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State | LA
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Zip | 71101-3910
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Country | US
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Telephone | 318-212-8951
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Fax | 318-212-6752
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | 0101226366
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License Number State | VA
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