Provider Demographics
NPI:1184789927
Name:MODESTO ARTS MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:MODESTO ARTS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PFEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-602-6126
Mailing Address - Street 1:2625 COFFEE RD SUITE F #248
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-985-6291
Mailing Address - Fax:209-522-7956
Practice Address - Street 1:2525 COFFEE RD SUITE F #248
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-522-1027
Practice Address - Fax:209-522-7956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty