Provider Demographics
NPI:1427024348
Name:FELTON, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:FELTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1620 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2251
Mailing Address - Country:US
Mailing Address - Phone:219-462-0309
Mailing Address - Fax:219-464-4291
Practice Address - Street 1:1620 COUNTRY CLUB RD
Practice Address - Street 2:SUITE D
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2251
Practice Address - Country:US
Practice Address - Phone:219-462-0309
Practice Address - Fax:219-464-4291
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01028127207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB52737Medicare UPIN
IN656540BMedicare ID - Type Unspecified