Healthcare Provider Details

I. General information

NPI: 1730157744
Provider Name (Legal Business Name): BARBARA M FONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. BARBARA MEI HONG FONG GRESS

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 COFFEE RD
MODESTO CA
95355-4201
US

IV. Provider business mailing address

600 COFFEE RD
MODESTO CA
95355-4201
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-6097
  • Fax:
Mailing address:
  • Phone: 209-521-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15294
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG55760
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG55760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: