Organization
GREATER MODESTO MEDICAL SURGICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN R PORTEOUS M.D. (M.D.)
(209) 577-3388
Entity
Organization
Contact information
Practice address
205 W GRANGER AVE, MODESTO, CA 95350-4402
(209) 577-3388
(209) 523-0764
Mailing address
1541 FLORIDA AVE, SUITE 200, MODESTO, CA 95350-4423
(209) 577-3388
(209) 523-0764
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD069A
MEDICARE GROUP PTAN
CA
Enumeration date
06/15/2011
Last updated
06/15/2011
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