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Organization
JONATHAN E FOW MD INC
Active
Organization
JONATHAN E FOW MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN ELDREDGE FOW MD (PRESIDENT)
(805) 473-0700
Entity
Organization
Contact information
Practice address
200 STATION WAY, SUITE C, ARROYO GRANDE, CA 93420-3348
(805) 473-0700
(805) 473-5931
Mailing address
200 STATION WAY, SUITE C, ARROYO GRANDE, CA 93420-3348
(805) 473-0700
(805) 473-5931
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A78523
CA
332B00000X
Durable Medical Equipment & Medical Supplies
5816010001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A785230
BLUE SHIELD PIN
CA
05
—
00A785230
—
CA
01
—
7503617
AETNA PIN
CA
Enumeration date
01/03/2007
Last updated
02/11/2011
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