Provider Demographics
NPI:1891782256
Name:TELLES, JOHN G (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:TELLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1313 E HERNDON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3306
Mailing Address - Country:US
Mailing Address - Phone:559-439-6808
Mailing Address - Fax:559-439-9335
Practice Address - Street 1:1313 E HERNDON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3306
Practice Address - Country:US
Practice Address - Phone:559-439-6808
Practice Address - Fax:559-439-9335
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG35213207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G352130Medicaid
A46263Medicare UPIN
CA00G352130Medicaid