# STANISLAUS ORTHOPAEDICS SPORTS MEDICINE CLINIC

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

## Provider details

- **NPI number:** 1477746501
- **Authorized official:** GREG FIELDS (OFFICE MANAGER)
- **Authorized official phone:** (209) 572-3224

## Contact information

- **Practice address:** 609 E ORANGEBURG AVE, \#201, MODESTO, CA 95350-5512
- **Practice address phone:** (209) 572-3224
- **Practice address fax:** (209) 572-4528
- **Mailing address:** 609 E ORANGEBURG AVE, \#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 |
| 213E00000X | Podiatrist | — | NULL | — |
| 213E00000X | Podiatrist | — | — | — |

## Other

- **Enumeration date:** 08/22/2007
- **Last updated:** 08/22/2007