Healthcare Provider Details

I. General information

NPI: 1518991942
Provider Name (Legal Business Name): DAVID P ENFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CALIFORNIA ST
STOCKTON CA
95204-6019
US

IV. Provider business mailing address

3116 W MARCH LN STE 200
STOCKTON CA
95219-2370
US

V. Phone/Fax

Practice location:
  • Phone: 209-473-6555
  • Fax: 209-473-6544
Mailing address:
  • Phone: 209-473-6555
  • Fax: 209-473-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberG791360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: