Organization
GASTRO CONSULTANTS OF MODESTO
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) 751-7165
(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
02/05/2014
Last updated
02/05/2014
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