Provider Demographics
NPI:1417986506
Name:RICHARD A. CERCLE M.D.
Entity Type:Organization
Organization Name:RICHARD A. CERCLE M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GASTROENTEROLOGY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CERCLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-526-8038
Mailing Address - Street 1:1429 COLLEGE AVE
Mailing Address - Street 2:#B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1429 COLLEGE AVE
Practice Address - Street 2:#B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4057
Practice Address - Country:US
Practice Address - Phone:209-526-8038
Practice Address - Fax:209-526-6841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11715207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75818ZMedicare PIN