Provider Demographics
NPI:1962567586
Name:FOOX, GERALD P (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:P
Last Name:FOOX
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 8795
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711
Mailing Address - Country:US
Mailing Address - Phone:903-593-4949
Mailing Address - Fax:903-593-4950
Practice Address - Street 1:1405 S. FLEISHEL AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-593-4949
Practice Address - Fax:903-593-4950
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8473208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JY82Medicare UPIN
B18171Medicare UPIN
TXB17181Medicare UPIN