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
691 MORRO AVE, MORRO BAY, CA 93442-2233
(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
5816010002
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A785230
—
CA
Enumeration date
12/21/2006
Last updated
02/11/2011
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