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General NPI Number Information
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NPI Number | 1164453254
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Entity Type | Organization
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Legal Business Name | METABOLIC IMAGING MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 6121 N THESTA ST 207
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City | FRESNO
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State | CA
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Zip | 93710-8603
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Country | US
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Telephone | 559-449-2644
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27486
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City | FRESNO
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State | CA
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Zip | 93729-7486
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Country | US
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Telephone | 559-449-2644
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Fax | 559-449-2642
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL E STOBBE
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Credential | M.D.
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Telephone | 559-449-2644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number |
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License Number State |
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