Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 22411 | KY |
Y | 208600000X | Surgeon | 22411 | KY |
N | 2082S0105X | Plastic Hand Surgeon | 22411 | KY |
N | 2086S0105X | Surgery of the Hand | 22411 | KS |
N | 2086S0122X | Plastic and Reconstructive Surgery | 22411 | KY |
NPI | 1417001553 |
---|---|
Provider Name | Dr. Martin S Fox |
First Address | Louisville, KY 40207-4640 |
Second Address | Louisville, KY 40207-4640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 11/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000048439 | BLUE CROSS (01) | KY |
1051838 | PASSPORT (01) | KY |
4012461 | AETNA (01) | KY |
64224116 | (05) | KY |
C63776 | (02) | KY |