Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 22790 | OK |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 22790 | OK |
NPI | 1063495604 |
---|---|
Provider Name | Jeff A. Fox |
First Address | Tulsa, OK 74137-4265 |
Second Address | Tulsa, OK 74137-4265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100195280A | (05) | OK |
H50674 | (02) |