Provider Demographics
NPI:1346465259
Name:FOX, JILL MARQUART (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARQUART
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:ANNETTE
Other - Last Name:MARQUART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1406
Mailing Address - Country:US
Mailing Address - Phone:419-662-5555
Mailing Address - Fax:419-662-5547
Practice Address - Street 1:1200 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1406
Practice Address - Country:US
Practice Address - Phone:419-662-5555
Practice Address - Fax:419-662-5547
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064247F2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJI9303722Medicare UPIN
OHG35724Medicare UPIN
OHFO0808168Medicare UPIN