Provider Demographics
NPI:1114927050
Name:FELLER, JOHN FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANCIS
Last Name:FELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74785 US HIGHWAY 111
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-7128
Mailing Address - Country:US
Mailing Address - Phone:760-776-8989
Mailing Address - Fax:760-501-0311
Practice Address - Street 1:74785 US HIGHWAY 111
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7128
Practice Address - Country:US
Practice Address - Phone:760-776-8989
Practice Address - Fax:760-501-0311
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG654342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300138937OtherRAILROAD MEDICARE
CA00G654340Medicaid
CA00G654340OtherBLUE SHIELD
CA00G654340Medicare PIN
CAF09933Medicare UPIN