Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 2022053 | NJ |
NPI | 1053647636 |
---|---|
Provider Name | Dr. Ira L Fox |
First Address | Glassboro, NJ 08028-2706 |
Second Address | Glassboro, NJ 08028-2706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2009 |
Last Update Date | 02/11/2009 |