Provider Demographics
NPI:1063561926
Name:FOX, JONATHAN JAMES (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JAMES
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 THREE SPRINGS BLVD
Mailing Address - Street 2:SUITE 294
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8296
Mailing Address - Country:US
Mailing Address - Phone:970-764-3207
Mailing Address - Fax:970-764-3338
Practice Address - Street 1:1010 THREE SPRINGS BLVD
Practice Address - Street 2:SUITE 294
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8296
Practice Address - Country:US
Practice Address - Phone:970-764-3207
Practice Address - Fax:970-764-3338
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83743207L00000X
CODR.0054218207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A837430Medicaid
I34503Medicare UPIN