Individual
BARBARA M FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
15294
AZ
207L00000X
Anesthesiology Physician
Primary
G55760
CA
208VP0014X
Interventional Pain Medicine Physician
G55760
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280438
—
AZ
01
—
AZ0447090
BCBS
AZ
Enumeration date
03/08/2006
Last updated
01/27/2014
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