Individual
MR. JON R FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10798 W OVERLAND RD, BOISE, ID 83709
(208) 377-3368
(208) 322-4691
Mailing address
10798 W OVERLAND RD, BOISE, ID 83709-1329
(208) 377-3368
(208) 322-4691
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-001388
IL
363A00000X
Physician Assistant
Primary
PA-1083
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970025826
RAILRAOD MEDICARE
—
Enumeration date
02/01/2006
Last updated
06/15/2021
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