1598391203 NPI number — KENNETH RICHARD FOX

Table of content: KENNETH RICHARD FOX (NPI 1598391203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598391203 NPI number — KENNETH RICHARD FOX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX
Provider First Name:
KENNETH
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598391203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 DELAPORT
Provider Second Line Business Mailing Address:
POB CB 11148
Provider Business Mailing Address City Name:
NASSAU, BAHAMAS
Provider Business Mailing Address State Name:
NEW PROVIDENCE
Provider Business Mailing Address Postal Code:
00000
Provider Business Mailing Address Country Code:
BS
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 DELAPORT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASSAU, BAHAMAS
Provider Business Practice Location Address State Name:
OUTSIDE USA
Provider Business Practice Location Address Postal Code:
00000
Provider Business Practice Location Address Country Code:
BS
Provider Business Practice Location Address Telephone Number:
416-800-1647
Provider Business Practice Location Address Fax Number:
780-628-1414
Provider Enumeration Date:
03/14/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  E9640 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000 . This is a "NONE AT PRESENT" identifier . This identifiers is of the category "OTHER".