Healthcare Provider Details

I. General information

NPI: 1477537231
Provider Name (Legal Business Name): TUOLUMNE RADIOLOGY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREENLEY RD
SONORA CA
95370-5200
US

IV. Provider business mailing address

4301 NORTHSTAR WAY
MODESTO CA
95356-9262
US

V. Phone/Fax

Practice location:
  • Phone: 209-342-2300
  • Fax: 209-524-4240
Mailing address:
  • Phone: 209-342-2300
  • Fax: 209-524-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: GREGORY JOHN SCHANER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 209-342-2300