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Organization
GREATER MODESTO MEDICAL SURGICAL ASSOCIATES INC.
Active
Organization
GREATER MODESTO MEDICAL SURGICAL ASSOCIATES INC.
Active
Other names
McHenry Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN R PORTEOUS M.D. (SHAREHOLDER)
(209) 577-3388
Entity
Organization
Contact information
Practice address
1541 FLORIDA AVE, SUITE 200, MODESTO, CA 95350-4429
(209) 577-3388
(209) 342-3743
Mailing address
1541 FLORIDA AVE, SUITE 200, MODESTO, CA 95350-4429
(209) 577-3388
(209) 342-3743
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
2088P0231X
Pediatric Urology Physician
—
—
Other
Enumeration date
05/12/2009
Last updated
10/05/2009
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