Individual
GRADIE B MIXON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4601 DALE ROAD, MODESTO, CA 95356
(209) 735-5000
Mailing address
604 CHERRY HILL CT, MODESTO, CA 95356-9556
(209) 522-9566
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G57069
CA
Other
Enumeration date
07/09/2006
Last updated
02/11/2022
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