Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1193 | MS |
NPI | 1386907897 |
---|---|
Provider Name | Dr. Jimmy L Fox |
First Address | Gulfport, MS 39507-2643 |
Second Address | Gulfport, MS 39507-2643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 19/06/2012 |