Provider Demographics
NPI:1497762892
Name:FELLOWS, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:FELLOWS
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:PO BOX 1062
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1062
Mailing Address - Country:US
Mailing Address - Phone:270-827-2915
Mailing Address - Fax:270-827-2995
Practice Address - Street 1:110 THIRD ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2993
Practice Address - Country:US
Practice Address - Phone:270-827-2915
Practice Address - Fax:270-643-0082
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY24878208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64757602Medicaid
KY5761Medicare PIN
KY64757602Medicaid
KY7064Medicare PIN
KY0706401Medicare PIN
KY0576101Medicare PIN