Provider Demographics
NPI:1053331058
Name:LINDA K FOX MD PA
Entity Type:Organization
Organization Name:LINDA K FOX MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-215-4369
Mailing Address - Street 1:619 COVE BLVE STE D
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401
Mailing Address - Country:US
Mailing Address - Phone:850-215-4369
Mailing Address - Fax:850-769-2366
Practice Address - Street 1:619 N COVE BLVD STE D
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3642
Practice Address - Country:US
Practice Address - Phone:850-215-4369
Practice Address - Fax:850-769-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266757600Medicaid
FL62994OtherBCBS OF FL
FL266757600Medicaid
FLP00180530Medicare ID - Type UnspecifiedMEDICARE RAILROAD
FL266757600Medicaid
FL=========OtherTAX ID
FLU1168AMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL