Provider Demographics
NPI:1518028513
Name:FOX, BRIAN W (PA-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:FOX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 SOMERSET PL
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-2862
Mailing Address - Country:US
Mailing Address - Phone:303-931-7408
Mailing Address - Fax:
Practice Address - Street 1:1201 PIPER BLVD STE 24
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1385
Practice Address - Country:US
Practice Address - Phone:239-260-5307
Practice Address - Fax:239-260-5308
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1835363A00000X
FLPA9114682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35624221Medicaid
COC514918Medicare ID - Type Unspecified
CO35624221Medicaid