Individual
JONATHAN E FOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
850 FAIR OAKS AVE STE 100, ARROYO GRANDE, CA 93420
(805) 473-0700
(805) 473-5931
Mailing address
850 FAIR OAKS AVE STE 100, ARROYO GRANDE, CA 93420-3929
(805) 473-0700
(805) 473-5931
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A78523
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
A78523
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A785230
BLUE SHIELD PIN
—
05
—
00A785230
—
CA
01
—
7503617
AETNA PIN
—
Enumeration date
07/16/2006
Last updated
11/02/2023
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