Organization
EXCELL E.N.T. MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA K JOHNSON (PRACTICE ADMINISTRATOR)
(209) 943-5185
Entity
Organization
Contact information
Practice address
645 W HARDING WAY, SUITE 6, STOCKTON, CA 95204-5688
(209) 943-5185
(209) 943-5187
Mailing address
645 W HARDING WAY, SUITE 6, STOCKTON, CA 95204-5688
(209) 943-5185
(209) 943-5187
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ66439Z
BLUE SHIELD
CA
Enumeration date
06/05/2006
Last updated
08/22/2020
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