Healthcare Provider Details

I. General information

NPI: 1750721262
Provider Name (Legal Business Name): DAVID DENNIS NEGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 HERNDON AVE CENTRAL VALLEY INDIAN HEALTH, INC
CLOVIS CA
93611-6813
US

IV. Provider business mailing address

2740 HERNDON AVE CENTRAL VALLEY INDIAN HEALTH INC
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-2578
  • Fax: 559-299-0245
Mailing address:
  • Phone: 559-299-2578
  • Fax: 559-299-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA139387
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA139387
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number074496
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: