Healthcare Provider Details

I. General information

NPI: 1114967197
Provider Name (Legal Business Name): JEFFREY S MOGELOF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-5328
  • Fax: 559-228-6943
Mailing address:
  • Phone: 559-228-5328
  • Fax: 559-228-6943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG41267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: