Provider Demographics
NPI:1346419686
Name:FOX, ROBERT JASON (DOM, LAC, APNP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JASON
Last Name:FOX
Suffix:
Gender:M
Credentials:DOM, LAC, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 N DR MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1484
Mailing Address - Country:US
Mailing Address - Phone:414-640-5433
Mailing Address - Fax:414-502-0192
Practice Address - Street 1:3338 N DR MARTIN LUTHER KING JR DR FL 2
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1484
Practice Address - Country:US
Practice Address - Phone:414-640-5433
Practice Address - Fax:414-502-0192
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI383-055171100000X
WI4476-33363LF0000X, 363LP2300X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No171100000XOther Service ProvidersAcupuncturist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MF2432792OtherDEA