Provider Demographics
NPI:1770600884
Name:FOX, STEPHANIE J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:J
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 KENNARD ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5465
Mailing Address - Country:US
Mailing Address - Phone:651-326-1044
Mailing Address - Fax:
Practice Address - Street 1:3100 KENNARD ST
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5465
Practice Address - Country:US
Practice Address - Phone:651-326-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104273207K00000X
MO2008008163208M00000X
MN52217207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNP0083991OtherMEDICARE RAIL ROAD
IAENROLLEDMedicaid
MNP0083991OtherMEDICARE RAIL ROAD