Provider Demographics
NPI:1295893329
Name:FOXEN, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FOXEN
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 1:2250 CHAMPLAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2618
Mailing Address - Country:US
Mailing Address - Phone:202-232-9022
Mailing Address - Fax:202-232-8494
Practice Address - Street 1:2250 CHAMPLAIN ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2618
Practice Address - Country:US
Practice Address - Phone:202-232-9022
Practice Address - Fax:202-232-8494
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207368804Medicaid
MO207368804Medicaid
MO000012436Medicare PIN