Provider Demographics
NPI:1417001553
Name:FOX, MARTIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:S
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4001 KRESGE WAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4640
Mailing Address - Country:US
Mailing Address - Phone:502-895-5850
Mailing Address - Fax:502-895-1210
Practice Address - Street 1:4001 KRESGE WAY
Practice Address - Street 2:SUITE 320
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-895-5850
Practice Address - Fax:502-895-1210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22411208200000X, 2082S0105X, 2082S0099X, 2086S0122X
KS224112086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1051838OtherPASSPORT
KY000000048439OtherBLUE CROSS
KY4012461OtherAETNA
KY64224116Medicaid
KY1051838OtherPASSPORT
KYC63776Medicare UPIN