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Organization
MARK T. FAHLEN, MD, INC. A PROFESSIONAL MEDICAL CORPORATION
Active
Organization
MARK T. FAHLEN, MD, INC. A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK THEODORE FAHLEN M.D. (PRESIDENT)
(209) 544-2910
Entity
Organization
Contact information
Practice address
1400 FLORIDA AVE, SUITE 109, MODESTO, CA 95350-4422
(209) 544-2910
(209) 544-2253
Mailing address
1400 FLORIDA AVE, SUITE 109, MODESTO, CA 95350-4422
(209) 544-2910
(209) 544-2253
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A81212
CA
Other
Enumeration date
08/03/2008
Last updated
08/02/2011
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