Organization
ADVANCED SLEEP AND GASTROENTEROLOGY LABORATORIES, INC
Active
Organization
ADVANCED SLEEP AND GASTROENTEROLOGY LABORATORIES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN SAM DAVIDSON M.D. (CEO)
(209) 751-7165
Entity
Organization
Contact information
Practice address
4206 TECHNOLOGY DR, SUITE 2, MODESTO, CA 95356-8769
(209) 492-0735
(209) 579-2354
Mailing address
PO BOX 3068, CERES, CA 95307-9032
(209) 751-7165
(209) 579-2354
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G66389
CA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
G66389
CA
Other
Enumeration date
08/22/2013
Last updated
08/22/2013
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