Individual
MARK T FAHLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 FLORIDA AVE, SUITE 109, MODESTO, CA 95350-4422
(209) 544-2910
Mailing address
1400 FLORIDA AVE, SUITE 109, MODESTO, CA 95350-4422
(209) 544-2910
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A81212
CA
207RN0300X
Nephrology Physician
Primary
A81212
CA
Other
Enumeration date
04/21/2006
Last updated
08/02/2011
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