Healthcare Provider Details

I. General information

NPI: 1780675017
Provider Name (Legal Business Name): TURLOCK EMERGENCY PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DELBON AVE
TURLOCK CA
95382-2016
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 Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1546
License Number StateCA

VIII. Authorized Official

Name: GORDON ELWOOD ALLDRIN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 209-342-2300