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General NPI Number Information
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NPI Number | 1962431387
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Entity Type | Individual
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Provider Name | ROBERT E FOX PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 404 NW HALL OF FAME DR
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City | LAKE CITY
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State | FL
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Zip | 32055-4833
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Country | US
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Telephone | 386-287-0410
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Fax | 386-287-0411
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Provider Business Mailing Address
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Address Line | 705 WELLS RD STE 300
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City | ORANGE PARK
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State | FL
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Zip | 32073-2982
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Country | US
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Telephone | 386-287-0410
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Fax | 386-287-0411
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA1873
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1873
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License Number State | FL
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