Active NPI
Lars Peter Enevoldsen, M.D.
- Plastic Surgery Physician
- Modesto, CA
National Provider Identifier
1437356235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- G56199
- Practice address
- 220 W Orangeburg Ave
Modesto, CA 95350-4417 - Phone
- (209) 524-6204
- Fax
- (209) 524-0405
- NPI assigned
- Jun 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | G56199 | CA | Primary |
Addresses
Primary practice location
220 W Orangeburg Ave
Modesto, CA 95350-4417
Mailing address
220 W Orangeburg Ave
Modesto, CA 95350-4417
Phone (209) 524-6204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G56199 | CA | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437356235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 W ORANGEBURG AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504417",
"telephone_number": "209-524-6204",
"fax_number": "209-524-0405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 W ORANGEBURG AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504417",
"telephone_number": "209-524-6204",
"fax_number": "209-524-0405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENEVOLDSEN",
"first_name": "LARS",
"middle_name": "PETER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "CA",
"license": "G56199",
"primary": true
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.