Healthcare Provider Details

I. General information

NPI: 1093137051
Provider Name (Legal Business Name): ORION ORTHOPAEDIC TRAUMA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 COFFEE RD STE 100
MODESTO CA
95355-3192
US

IV. Provider business mailing address

1335 COFFEE RD STE 100
MODESTO CA
95355-3192
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-4649
  • Fax: 209-524-7395
Mailing address:
  • Phone: 209-524-4649
  • Fax: 209-524-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberG81678
License Number StateCA

VIII. Authorized Official

Name: WILLIAM J HOLMES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 209-524-4649