Individual
MR. JEFFERY B FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
818 CONGRESS ST, PORTLAND, ME 04102-3112
(207) 773-8161
Mailing address
220 CAMPUS BLVD STE 100, WINCHESTER, VA 22601-2896
(540) 536-5100
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
1338-023
WI
363AS0400X
Surgical Physician Assistant
5601006358
MI
363AS0400X
Surgical Physician Assistant
Primary
PA2288
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41925000
—
WI
01
—
P52980059
MEDICARE
MI
Enumeration date
04/03/2006
Last updated
04/04/2022
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