Provider Demographics
NPI:1598391203
Name:FOX, KENNETH RICHARD
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RICHARD
Last Name:FOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DELAPORT
Mailing Address - Street 2:POB CB 11148
Mailing Address - City:NASSAU, BAHAMAS
Mailing Address - State:NEW PROVIDENCE
Mailing Address - Zip Code:00000
Mailing Address - Country:BS
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 DELAPORT
Practice Address - Street 2:
Practice Address - City:NASSAU, BAHAMAS
Practice Address - State:OUTSIDE USA
Practice Address - Zip Code:00000
Practice Address - Country:BS
Practice Address - Phone:416-800-1647
Practice Address - Fax:780-628-1414
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9640207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherNONE AT PRESENT