Provider Demographics
NPI:1538652839
Name:FOX, BRETON (DPM)
Entity Type:Individual
Prefix:
First Name:BRETON
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-5101
Mailing Address - Country:US
Mailing Address - Phone:603-668-3509
Mailing Address - Fax:603-641-8442
Practice Address - Street 1:424 HANOVER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-5101
Practice Address - Country:US
Practice Address - Phone:603-668-3509
Practice Address - Fax:603-641-8442
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0379213ES0103X
VT061.0000025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery