=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679521066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRA J FOX MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 08/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4401 PENN AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15224-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-559-9800
-----------------------------------------------------
Fax | 402-559-9840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4401 PENN AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15224-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-559-9800
-----------------------------------------------------
Fax | 402-559-9840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204F00000X
-----------------------------------------------------
Taxonomy Name | Transplant Surgery Physician
-----------------------------------------------------
License Number | 18822
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------