Basic Information
| Provider Information | |||||||||
| NPI: | 1336124247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3413 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165082678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148689828 | ||||||||
| FaxNumber: | 8148688561 | ||||||||
| Practice Location | |||||||||
| Address1: | 3413 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165082678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148689828 | ||||||||
| FaxNumber: | 8148688561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD050885L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.