Basic Information
| Provider Information | |||||||||
| NPI: | 1164438099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 LOUISIANA AVE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711013910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182128951 | ||||||||
| FaxNumber: | 3182126752 | ||||||||
| Practice Location | |||||||||
| Address1: | 7925 YOUREE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182123610 | ||||||||
| FaxNumber: | 3182123709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XP3100X | 0101226366 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200001150 | 01 | VA | MEDICARE | OTHER | 311610834 | 01 | VA | VHN | OTHER | 006402500 | 01 | VA | VA. PREMIER | OTHER | 09-00933 | 01 | VA | UHC | OTHER | MD.206342 | 01 | LA | LOUISIANA STATE BOARD OF MEDICAL EXAMINERS - MEDICINE AND SURGERY | OTHER | 006402500 | 05 | VA | MEDICAID | 279227 | 01 | VA | ALLIANCE/MDIPA | OTHER | 2378741 | 05 | LA | MEDICAID | 7263169015 | 01 | VA | CIGNA | OTHER | 311610834 | 01 | VA | TRICARE | OTHER | 5485178 | 01 | VA | AETNA | OTHER | 615723 | 01 | VA | NC PPO | OTHER | 381727 | 01 | VA | ANTHEM BCBS | OTHER | 89063C9 | 01 | VA | NORTH CAROLINA MEDICAID | OTHER | 27603 | 01 | VA | OPTIMA/SENTARA HEALTH | OTHER | 279227 | 01 | VA | MAMSI/OPTIMUM CHOICE | OTHER | 311610834 | 01 | VA | BEECH STREET | OTHER |