Basic Information
Provider Information
NPI: 1780675017
EntityType: 2
ReplacementNPI:  
OrganizationName: TURLOCK EMERGENCY PHYSICIANS MEDICAL GROUP INC
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Mailing Information
Address1: 4301 NORTHSTAR WAY
Address2:  
City: MODESTO
State: CA
PostalCode: 953569262
CountryCode: US
TelephoneNumber: 2093422300
FaxNumber: 2095244240
Practice Location
Address1: 825 DELBON AVE
Address2:  
City: TURLOCK
State: CA
PostalCode: 953822016
CountryCode: US
TelephoneNumber: 2093422300
FaxNumber: 2095244240
Other Information
ProviderEnumerationDate: 11/04/2005
LastUpdateDate: 08/22/2020
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AuthorizedOfficialLastName: ALLDRIN
AuthorizedOfficialFirstName: GORDON
AuthorizedOfficialMiddleName: ELWOOD
AuthorizedOfficialTitleorPosition: MEDICAL DIRECTOR
AuthorizedOfficialTelephone: 2093422300
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X1546CAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 

ID Information
IDTypeStateIssuerDescription
GR004550005CA MEDICAID
ZZZ24670Z01CABLUE SHIELDOTHER


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