Individual
DR. JOHN GREGG FOZARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5383 STATE ROUTE 154, PINCKNEYVILLE, IL 62274-3342
(618) 357-2131
(618) 357-3411
Mailing address
5383 STATE ROUTE 154, PO BOX 437, PINCKNEYVILLE, IL 62274-3342
(618) 357-2131
(618) 357-3411
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036053225
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0027340080
BCBS PHYS PROVIDER #
IL
01
—
034761
HEALTH ALLIANCE ID
IL
05
—
036053225
—
IL
01
—
080174912
MEDICARE RAILROAD
IL
01
—
122435
HEALTHLINK PROVIDER ID
IL
01
—
2288028
UNITED HEALTHCARE ID
IL
01
—
7320380
BCBS FMC GROUP PROVIDER #
IL
Enumeration date
02/07/2006
Last updated
07/10/2023
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