Provider Demographics
NPI:1205917010
Name:FOX, JARED GEORGE (CRNA)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:GEORGE
Last Name:FOX
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 NELSON ROAD
Mailing Address - Street 2:BUILDING A SUITE 4
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4196
Mailing Address - Country:US
Mailing Address - Phone:337-474-6353
Mailing Address - Fax:337-477-7616
Practice Address - Street 1:4150 NELSON ROAD
Practice Address - Street 2:BUILDING A SUITE 4
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4196
Practice Address - Country:US
Practice Address - Phone:337-474-6353
Practice Address - Fax:337-477-7616
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04937367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered