Provider Demographics
NPI:1689779191
Name:FOX, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SOUTH CEDAR AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-1305
Mailing Address - Country:US
Mailing Address - Phone:423-228-4159
Mailing Address - Fax:
Practice Address - Street 1:325 SOUTH CEDAR AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1305
Practice Address - Country:US
Practice Address - Phone:423-228-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31310208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0101OtherUNITED HEALTHCARE OF RIVER VALLEY PROVIDER NUMBER
TN1504527Medicaid
TNTN0101OtherAMERICHOICE PROVIDER NUMBER
TN4076373OtherBCBS PROVIDER NUMBER
TN4076373OtherBCBS PROVIDER NUMBER