Individual
MARCUS GEORGE CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
C50251
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C502510
—
CA
Enumeration date
03/10/2006
Last updated
11/01/2016
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