Provider Demographics
NPI:1104116631
Name:FOX, JENNIFER MELISSA LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MELISSA LEE
Last Name:FOX
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:104 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4819
Mailing Address - Country:US
Mailing Address - Phone:352-726-4818
Mailing Address - Fax:
Practice Address - Street 1:104 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4819
Practice Address - Country:US
Practice Address - Phone:352-726-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006555213ES0103X
FLPO3648213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery