Healthcare Provider Details

I. General information

NPI: 1598800062
Provider Name (Legal Business Name): JAMES ALLEN GAMMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: J. ALLEN GAMMON MD

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 COFFEE ROAD SUITE F
MODESTO CA
95355
US

IV. Provider business mailing address

500 COFFEE ROAD SUITE F
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-7362
  • Fax: 209-522-7314
Mailing address:
  • Phone: 209-522-8004
  • Fax: 209-522-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC334380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: