Provider Demographics
NPI:1104847128
Name:FOX, DONNA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4650 AMBASSADOR CAFFERY PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6926
Mailing Address - Country:US
Mailing Address - Phone:337-504-5200
Mailing Address - Fax:337-504-5150
Practice Address - Street 1:4650 AMBASSADOR CAFFERY PKWY STE 204
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6926
Practice Address - Country:US
Practice Address - Phone:337-504-5200
Practice Address - Fax:337-504-5150
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019491208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1092438Medicaid
LA1092438Medicaid
E78010Medicare UPIN