# INDRA DE M.D., INC.

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

## Provider details

- **NPI number:** 1316147986
- **Authorized official:** DR. INDRA DE MD (PRESIDENT)
- **Authorized official phone:** (209) 462-9100

## Contact information

- **Practice address:** 2333 W MARCH LN STE A1, STOCKTON, CA 95207-5263
- **Practice address phone:** (209) 462-9100
- **Practice address fax:** (209) 462-9101
- **Mailing address:** 3905 GLEN ABBY CIR, STOCKTON, CA 95219-1800
- **Mailing address phone:** (209) 462-9100
- **Mailing address fax:** (209) 462-9101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | C52396 | CA | Yes |

## Other

- **Enumeration date:** 07/23/2007
- **Last updated:** 03/11/2019