Provider Demographics
NPI:1639174584
Name:ARDRON, MARIGOLD JABBOUR (MD)
Entity Type:Individual
Prefix:
First Name:MARIGOLD
Middle Name:JABBOUR
Last Name:ARDRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 COFFEE RD
Mailing Address - Street 2:STE S
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2050
Mailing Address - Country:US
Mailing Address - Phone:208-577-1200
Mailing Address - Fax:209-577-6517
Practice Address - Street 1:2625 COFFEE RD
Practice Address - Street 2:STE S
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2050
Practice Address - Country:US
Practice Address - Phone:208-577-1200
Practice Address - Fax:209-577-6517
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66626207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66626OtherLICENSE
CAH78761Medicare UPIN
CAG66626OtherLICENSE
CA00G666260Medicare ID - Type Unspecified