Provider Demographics
NPI:1619975711
Name:FOX, IRA M (DPM)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:M
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 1:24 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1776
Mailing Address - Country:US
Mailing Address - Phone:609-927-1991
Mailing Address - Fax:609-926-0075
Practice Address - Street 1:24 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1776
Practice Address - Country:US
Practice Address - Phone:609-927-1991
Practice Address - Fax:609-926-0075
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002172-L213ES0103X, 213ES0103X
NJ25MD00129700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAF9336911OtherDEA
T44675Medicare UPIN