Healthcare Provider Details

I. General information

NPI: 1265485924
Provider Name (Legal Business Name): SPINE AND ORTHOPAEDIC MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 N FRESNO ST SUITE 110
FRESNO CA
93720-1538
US

IV. Provider business mailing address

8405 N FRESNO ST SUITE 110
FRESNO CA
93720-1537
US

V. Phone/Fax

Practice location:
  • Phone: 559-449-7645
  • Fax: 559-432-1915
Mailing address:
  • Phone: 559-449-7645
  • Fax: 559-432-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. PAUL JAMES NUGENT
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 559-449-7645