Organization
ANESTHESIA SPECIALISTS MEDICAL GROUP,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN JOHN THORUP MD (PRESIDENT)
(209) 529-9603
Entity
Organization
Contact information
Practice address
1441 FLORIDA AVENUE, DOCTORS MEDICAL CENTER, MODESTO, CA 95350
(209) 578-1211
Mailing address
817 COFFEE ROAD, C3, MODESTO, CA 95355
(209) 529-9603
(209) 529-6610
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G75791
CA
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
G75791
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0102320
—
CA
Enumeration date
10/23/2006
Last updated
12/08/2014
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