Organization
ADVANCED SLEEP AND GASTROENTEROLOGY LABORATORIES,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN SAM DAVIDSON MD (CEO)
(209) 751-7165
Entity
Organization
Contact information
Practice address
4206 TECHNOLOGY DR STE 2, MODESTO, CA 95356-8769
(209) 492-0735
(209) 579-2354
Mailing address
262 BURGENLAND AVE, TURLOCK, CA 95382-0343
(209) 751-7165
(209) 579-2354
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
10/14/2011
Last updated
10/14/2011
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