Provider Demographics
NPI:1861832008
Name:JOSHUA R. MODLIN DPM
Entity Type:Organization
Organization Name:JOSHUA R. MODLIN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MODLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:661-836-8154
Mailing Address - Street 1:7850 WHITE LN STE E116
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7698
Mailing Address - Country:US
Mailing Address - Phone:661-800-1924
Mailing Address - Fax:661-833-0500
Practice Address - Street 1:5400 ALDRIN CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2103
Practice Address - Country:US
Practice Address - Phone:661-800-1924
Practice Address - Fax:661-833-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4960213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty