# GREATER MODESTO MEDICAL SURGICAL ASSOCIATES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134499411
- **Authorized official:** MR. JOHN R PORTEOUS M.D. (PRESIDENT)
- **Authorized official phone:** (209) 577-3388

## Contact information

- **Practice address:** 1262 E NORTH ST, SUITE B, MANTECA, CA 95336-4962
- **Practice address phone:** (209) 214-7053
- **Practice address fax:** (209) 523-0764
- **Mailing address:** 1541 FLORIDA AVE, SUITE 200, MODESTO, CA 95350-4423
- **Mailing address phone:** (209) 577-3388
- **Mailing address fax:** (209) 523-0764

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/04/2012
- **Last updated:** 01/04/2012