Healthcare Provider Details

I. General information

NPI: 1679831291
Provider Name (Legal Business Name): FIRST CHOICE PHYSICIAN PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FLORIDA AVE STE 100, B
MODESTO CA
95350-4429
US

IV. Provider business mailing address

1541 FLORIDA AVE STE. 200
MODESTO CA
95350-4429
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-3388
  • Fax: 209-338-1111
Mailing address:
  • Phone: 209-214-7053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF KOURY
Title or Position: CEO
Credential:
Phone: 714-428-6842