Provider Demographics
NPI:1295775864
Name:FOX, KEITH C (DPM)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:C
Last Name:FOX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2734 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-256-7701
Mailing Address - Fax:803-733-3444
Practice Address - Street 1:2734 RIVER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-775-6969
Practice Address - Fax:803-775-9607
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC49213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0139470001Medicare NSC
SCT24981Medicare UPIN