MEDICARE: ROBERT BRIAN FOX PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant	1045564	GA

General Provider Information

NPI Number	:	1275532442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BRIAN FOX PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	6995 BUCKHORN DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3214
Country	:	US
Telephone Number	:	706-593-8979
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 9053
Second Line	:	FT BENNING
City	:	COLUMBUS
State	:	GA
Zip	:	31905
Country	:	US
Telephone Number	:	706-544-1833
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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