Provider Demographics
NPI:1164438099
Name:FOX, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1202 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3910
Mailing Address - Country:US
Mailing Address - Phone:318-212-8951
Mailing Address - Fax:318-212-6752
Practice Address - Street 1:7925 YOUREE DR STE 200
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5134
Practice Address - Country:US
Practice Address - Phone:318-212-3610
Practice Address - Fax:318-212-3709
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101226366207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA200001150OtherMEDICARE
VA311610834OtherVHN
VA006402500OtherVA. PREMIER
VA09-00933OtherUHC
LAMD.206342OtherLOUISIANA STATE BOARD OF MEDICAL EXAMINERS - MEDICINE AND SURGERY
VA006402500Medicaid
VA279227OtherALLIANCE/MDIPA
LA2378741Medicaid
VA7263169015OtherCIGNA
VA311610834OtherTRICARE
VA5485178OtherAETNA
VA615723OtherNC PPO
VA381727OtherANTHEM BCBS
VA89063C9OtherNORTH CAROLINA MEDICAID
VA27603OtherOPTIMA/SENTARA HEALTH
VA279227OtherMAMSI/OPTIMUM CHOICE
VA311610834OtherBEECH STREET