Organization Active NPI

Advanced Sleep and Gastroenterology Laboratories,Inc.

  • Gastroenterology Physician
  • Modesto, CA
National Provider Identifier
1396020947
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
ADVANCED SLEEP AND GASTROENTEROLOGY LABORATORIES,INC.
Practice address
4206 Technology Dr Ste 2
Modesto, CA 95356-8769
Phone
(209) 492-0735
Fax
(209) 579-2354
NPI assigned
Oct 14, 2011
Last updated
Oct 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

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

Authorized official

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

Specialties & licenses 2

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

Addresses

Primary practice location

4206 Technology Dr Ste 2
Modesto, CA 95356-8769

Mailing address

262 Burgenland Ave
Turlock, CA 95382-0343
Phone (209) 751-7165

National Provider Directory

National Provider Directory

Locations

4206 Technology Dr
Ste 2
Modesto, CA 95356
Phone (209) 492-0735

2210 Del Paso Rd
Ste B
Sacramento, CA 95834
Phone (916) 561-0530

7540 Shoreline Dr
Ste C
Stockton, CA 95219
Phone (209) 957-1992

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318550400000",
    "number": "1396020947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 BURGENLAND AVE",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953820343",
            "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 STE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568769",
            "telephone_number": "209-492-0735",
            "fax_number": "209-579-2354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SLEEP AND GASTROENTEROLOGY LABORATORIES,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2011-10-14",
        "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": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "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 Oct 14, 2011; 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.