Healthcare Provider Details

I. General information

NPI: 1427079581
Provider Name (Legal Business Name): FRESNO IMAGING CENTER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W FIR AVE
CLOVIS CA
93611-0220
US

IV. Provider business mailing address

231 W FIR AVE
CLOVIS CA
93611-0220
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-0300
  • Fax: 559-323-5461
Mailing address:
  • Phone: 559-297-0300
  • Fax: 559-323-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DAVID ALSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-297-0300