Provider Demographics
NPI:1528343639
Name:CANDACE FOX, M.D., P.A.
Entity type:Organization
Organization Name:CANDACE FOX, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-661-6336
Mailing Address - Street 1:6090 BIRD RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5252
Mailing Address - Country:US
Mailing Address - Phone:305-661-6336
Mailing Address - Fax:305-661-5256
Practice Address - Street 1:6090 BIRD RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5252
Practice Address - Country:US
Practice Address - Phone:305-661-6336
Practice Address - Fax:305-661-5256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG77343Medicare UPIN