Organization
MODESTO SURGICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARRIE PAYNE (SUPERVISOR)
(209) 525-3835
Entity
Organization
Contact information
Practice address
1401 SPANOS CT, 127, MODESTO, CA 95355-2810
(209) 525-3848
(209) 525-3886
Mailing address
1401 SPANOS CT, 127, MODESTO, CA 95355-2810
(209) 525-3848
(209) 525-3886
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086S0127X
Trauma Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0076520
—
CA
Enumeration date
07/19/2006
Last updated
01/11/2008
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