Provider Demographics
NPI:1104968783
Name:FOX, KEVIN BRIAN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRIAN
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:PO BOX 219
Mailing Address - Street 2:9490 HIGHWAY 10
Mailing Address - City:PALMETTO
Mailing Address - State:LA
Mailing Address - Zip Code:71358-0219
Mailing Address - Country:US
Mailing Address - Phone:337-623-4262
Mailing Address - Fax:
Practice Address - Street 1:9490 HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:LA
Practice Address - Zip Code:71358-0219
Practice Address - Country:US
Practice Address - Phone:337-623-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD06944R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1356638Medicaid
B62785Medicare UPIN
51065Medicare ID - Type Unspecified