Individual
DR. PARDEEP S BRAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD,
Contact information
Practice address
803 COFFEE RD, SUITE 5, MODESTO, CA 95355-4227
(209) 624-8780
(209) 208-3292
Mailing address
PO BOX 3346, MODESTO, CA 95353-3346
(209) 484-9855
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
C54142
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD069A
MEDICARE GROUP PTAN
CA
01
—
EP663Z
MEDICARE INDIVIDUAL PTAN
CA
Enumeration date
09/02/2005
Last updated
02/13/2013
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