Provider Demographics
NPI:1316172000
Name:FOX, ROGER NASH (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:NASH
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 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:SUITE #320
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5904
Mailing Address - Country:US
Mailing Address - Phone:907-729-8624
Mailing Address - Fax:907-729-8607
Practice Address - Street 1:4341 TUDOR CENTRE DR
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-729-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK74582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8EM819Medicare PIN
AK8EM820Medicare PIN
AK8EM818Medicare PIN
AK8EM823Medicare PIN
AK8EM821Medicare PIN
AK8EM822Medicare PIN
AK8EM816Medicare PIN
AK8EM817Medicare PIN