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NPI Code Detail

MEDICARE: DR. JOHN GREGG FOZARD M.D.

MEDICARE: DR. JOHN GREGG FOZARD M.D.
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
1207Q00000XFamily Medicine Physician036053225IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080174912OTHERILMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17320380OTHERILBCBS FMC GROUP PROVIDER #
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42288028OTHERILUNITED HEALTHCARE ID
50027340080OTHERILBCBS PHYS PROVIDER #
6034761OTHERILHEALTH ALLIANCE ID
7122435OTHERILHEALTHLINK PROVIDER ID

General Provider Information

NPI Number : 1689646127
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN GREGG FOZARD M.D.
Provider Business Mailing Address
First Line : 5383 STATE ROUTE 154
Second Line : PO BOX 437
City : PINCKNEYVILLE
State : IL
Zip : 62274-3342
Country : US
Telephone Number : 618-357-2131
Fax Number : 618-357-3411
Provider Business Practice Location Address
First Line : 5383 STATE ROUTE 154
Second Line :
City : PINCKNEYVILLE
State : IL
Zip : 62274-3342
Country : US
Telephone Number : 618-357-2131
Fax Number : 618-357-3411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 07/10/2023

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Directions to “ DR. JOHN GREGG FOZARD M.D.” Practice Location

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