Healthcare Provider Details

I. General information

NPI: 1215294160
Provider Name (Legal Business Name): FIRST CHOICE PHYSICIAN PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FLORIDA AVE STE 100
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: 209-575-5833
  • Fax: 209-575-5836
Mailing address:
  • Phone: 209-214-7053
  • Fax: 714-428-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF KOURY
Title or Position: CEO
Credential:
Phone: 714-428-6482