Provider Demographics
NPI:1700542552
Name:FOX, TIMOTHY EVAN (STUDENT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EVAN
Last Name:FOX
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13726 ELMBERRY LN APT 32
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-8529
Mailing Address - Country:US
Mailing Address - Phone:131-775-0839
Mailing Address - Fax:
Practice Address - Street 1:13726 ELMBERRY LN APT 32
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-8529
Practice Address - Country:US
Practice Address - Phone:131-775-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory