Individual
JEFFREY J FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1250 E MICHIGAN AVE, GRAYLING, MI 49738-7074
(989) 348-0550
Mailing address
1250 E MICHIGAN AVE, C/O PAYER ENROLLMENT, GRAYLING, MI 49738-7074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002952
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700F96001
BLUE SHIELD
MI
Enumeration date
07/18/2006
Last updated
12/12/2022
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