Provider Demographics
NPI:1770621898
Name:FOX, BRYAN JASON (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JASON
Last Name:FOX
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 1:4042 MIDDLEBROOK RD APT 1413
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-6773
Mailing Address - Country:US
Mailing Address - Phone:407-625-6551
Mailing Address - Fax:
Practice Address - Street 1:4042 MIDDLEBROOK RD APT 1413
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-6773
Practice Address - Country:US
Practice Address - Phone:407-625-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94839207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine