MEDICARE: MR. DAN L FOXX CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP3324602	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	430070033	OTHER	FL	MCRR
2	G2987Z	OTHER	FL	MCR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	G2987	OTHER	FL	BSFL

General Provider Information

NPI Number	:	1093705212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAN L FOXX CRNA

Provider Business Mailing Address
First Line	:	7152 COCA SABAL LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4263
Country	:	US
Telephone Number	:	239-939-9939
Fax Number	:	239-931-5078

Provider Business Practice Location Address
First Line	:	7152 COCA SABAL LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4263
Country	:	US
Telephone Number	:	239-939-9939
Fax Number	:	239-931-5078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	10/15/2008

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