Provider Demographics
NPI:1639163041
Name:FLETCHER, JOHN P (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 W SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-4102
Mailing Address - Country:US
Mailing Address - Phone:559-323-5660
Mailing Address - Fax:559-298-9002
Practice Address - Street 1:199 W SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-4102
Practice Address - Country:US
Practice Address - Phone:559-225-4706
Practice Address - Fax:559-225-4710
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A56751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A56751Medicare ID - Type Unspecified
CAE40029Medicare UPIN