Provider Demographics
NPI:1215344494
Name:FOX, JACOB N (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:N
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 1:800 ROSE STREET ANESTHESIOLOGY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-218-0069
Mailing Address - Fax:859-323-1080
Practice Address - Street 1:800 ROSE STREET ANESTHESIOLOGY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-218-0069
Practice Address - Fax:859-323-1080
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-19
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3484207L00000X
OH35.133517207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology