Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | E-1076 | AR |
NPI | 1114957537 |
---|---|
Provider Name | Dr. John Leroy Fox |
First Address | Little Rock, AR 72205-3404 |
Second Address | Little Rock, AR 72205-3404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B68061 | (02) | AR |