MEDICARE: DOCTORS MEDICAL CENTER OF MODESTO

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	261QR1300X	Rural Health Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1073944393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS MEDICAL CENTER OF MODESTO

Provider Business Mailing Address
First Line	:	PO BOX 743399
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-3399
Country	:	US
Telephone Number	:	209-573-6102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 W LAS PALMAS AVE
Second Line	:	STE E
City	:	PATTERSON
State	:	CA
Zip	:	95363-8873
Country	:	US
Telephone Number	:	209-895-7100
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL CMO; TENET
Name	:	DR. RONALD KAUFMAN
Credential	:
Telephone Number	:	714-428-6812

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	06/06/2016

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Directions to “DOCTORS MEDICAL CENTER OF MODESTO ” Practice Location

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