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General NPI Number Information
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NPI Number | 1992067631
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Entity Type | Organization
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Legal Business Name | PARDEEP BRAR M.D., INC.
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 803 COFFEE RD SUITE #5
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City | MODESTO
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State | CA
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Zip | 95355-4227
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Country | US
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Telephone | 209-484-9855
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3346
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City | MODESTO
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State | CA
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Zip | 95353-3346
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Country | US
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Telephone | 209-484-9855
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PARDEEP BRAR
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Credential | M.D.
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Telephone | 209-484-9855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | C54142
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License Number State | CA
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