# VALLEY ORTHOPAEDIC BONE AND JOINT

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

## Provider details

- **NPI number:** 1457836678
- **Authorized official:** JONATHAN MATTHEW PETTEGREW D.O. (SURGEON/PARTNER)
- **Authorized official phone:** (209) 572-3224

## Contact information

- **Practice address:** 609 E ORANGEBURG AVE STE 201, MODESTO, CA 95350-5512
- **Practice address phone:** (209) 572-3224
- **Practice address fax:** (209) 572-4528
- **Mailing address:** 609 E ORANGEBURG AVE STE 201, MODESTO, CA 95350-5512
- **Mailing address phone:** (209) 572-3224
- **Mailing address fax:** (209) 572-4528

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 2251X0800X | Orthopedic Physical Therapist | — | NULL | — |
| 2251X0800X | Orthopedic Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 10/03/2018
- **Last updated:** 10/03/2018