NPIMap

Organization Active NPI

Gastro Consultants of Modesto

  • Gastroenterology Physician
  • Modesto, CA
National Provider Identifier
1225452725
Registry record updated Feb 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
G66389 Issued in CA
Legal business name
GASTRO CONSULTANTS OF MODESTO
Practice address
4206 Technology Dr
Suite 2
Modesto, CA 95356-8769
Phone
(209) 751-7165
Fax
(209) 579-2354
NPI assigned
Feb 5, 2014
Last updated
Feb 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jonathan Sam Davidson, M.D.
Title
Ceo
Phone
(209) 751-7165

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X G66389 CA Primary
Sleep Medicine (Internal Medicine) Physician 207RS0012X G66389 CA

Addresses

Primary practice location

4206 Technology Dr
Suite 2
Modesto, CA 95356-8769

Mailing address

PO Box 3068
Ceres, CA 95307-9032
Phone (209) 751-7165

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391558400000",
    "number": "1225452725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3068",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953079032",
            "telephone_number": "209-751-7165",
            "fax_number": "209-579-2354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4206 TECHNOLOGY DR",
            "address_2": "SUITE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568769",
            "telephone_number": "209-751-7165",
            "fax_number": "209-579-2354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTRO CONSULTANTS OF MODESTO",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-05",
        "last_updated": "2014-02-05",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "SAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-751-7165",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "G66389",
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "CA",
            "license": "G66389",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.