Provider Demographics
NPI:1881686327
Name:FOX, SANDRA KAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:KAY
Last Name:FOX
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1928
Mailing Address - Country:US
Mailing Address - Phone:937-376-2002
Mailing Address - Fax:937-376-4042
Practice Address - Street 1:1063 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1928
Practice Address - Country:US
Practice Address - Phone:937-376-2002
Practice Address - Fax:937-376-4042
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002599F213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0809996Medicaid
OH0809996Medicaid
OH4871190001Medicare NSC
OHFO0652944Medicare PIN