Individual
DR. JOHN E. FELLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15025 INNOVATION DR, SAN DIEGO, CA 92128-3409
(858) 605-7960
Mailing address
54433 FILE, LOS ANGELES, CA 90074-0001
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
G60559
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G605590
—
CA
Enumeration date
09/01/2006
Last updated
06/25/2009
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