Healthcare Provider Details

I. General information

NPI: 1285741959
Provider Name (Legal Business Name): TERENCE J. SWEENEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE ROAD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

P.O. BOX 12020
WESTMINSTER CA
92685-2020
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4500
  • Fax:
Mailing address:
  • Phone: 888-556-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG53156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: