Provider Demographics
NPI:1508859646
Name:FOX, MICHAEL DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVIS
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7051 SOUTHPOINT PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8709
Mailing Address - Country:US
Mailing Address - Phone:904-493-2229
Mailing Address - Fax:904-396-4546
Practice Address - Street 1:7051 SOUTHPOINT PKWY
Practice Address - Street 2:STE 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8709
Practice Address - Country:US
Practice Address - Phone:904-493-2229
Practice Address - Fax:904-396-4546
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66312207VE0102X
GA049446207VE0102X
AL00023365207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020611OtherAETNA
FL25315ZOtherBLUE SHIELD
1716883001OtherCIGNA
209420OtherAVMED
D80596Medicare UPIN
25315Medicare ID - Type Unspecified