Individual
DR. LARS PETER ENEVOLDSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
220 W ORANGEBURG AVE, MODESTO, CA 95350-4417
(209) 524-6204
(209) 524-0405
Mailing address
220 W ORANGEBURG AVE, MODESTO, CA 95350-4417
(209) 524-6204
(209) 524-0405
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
G56199
CA
Other
Enumeration date
06/27/2007
Last updated
07/08/2007
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