Provider Demographics
NPI:1366768939
Name:FOX, CODY LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:LEE
Last Name:FOX
Suffix:
Gender:M
Credentials:DPM
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 1500
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 NICHOLS RD
Practice Address - Street 2:SUITE 1-2
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3093
Practice Address - Country:US
Practice Address - Phone:573-302-2828
Practice Address - Fax:573-302-2830
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001647213ES0103X
MI5901002257213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1366768939Medicaid
MO135570030Medicare PIN