Provider Demographics
NPI:1700826682
Name:ENDSLEY, LOUIS STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:STEPHEN
Last Name:ENDSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1540 FLORIDA AVE
Mailing Address - Street 2:#100
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-577-5557
Mailing Address - Fax:209-577-8125
Practice Address - Street 1:1540 FLORIDA AVE
Practice Address - Street 2:#100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-577-5557
Practice Address - Fax:209-577-8125
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG15337207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A39504Medicare UPIN
ZZZ76734ZMedicare ID - Type Unspecified