MEDICARE: MR. JOHN EDWARD FIELDS III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	A4973804	CA

General Provider Information

NPI Number	:	1942087325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN EDWARD FIELDS III

Provider Business Mailing Address
First Line	:	4307 INLET DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-4992
Country	:	US
Telephone Number	:	209-271-1553
Fax Number	:

Provider Business Practice Location Address
First Line	:	4307 INLET DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-4992
Country	:	US
Telephone Number	:	209-271-1553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	02/03/2026

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