Healthcare Provider Details

I. General information

NPI: 1073944393
Provider Name (Legal Business Name): DOCTORS MEDICAL CENTER OF MODESTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LAS PALMAS AVE STE E
PATTERSON CA
95363-8873
US

IV. Provider business mailing address

PO BOX 743399
LOS ANGELES CA
90074-3399
US

V. Phone/Fax

Practice location:
  • Phone: 209-895-7100
  • Fax:
Mailing address:
  • Phone: 209-573-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD KAUFMAN
Title or Position: REGIONAL CMO; TENET
Credential:
Phone: 714-428-6812