Doctor Name: | GEORGE I CONKLIN |
NPI Number: | 1205819836 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PA13790 |
Business Practice Address: | 1405 California Ave Dos Palos, CA - 936202300 |
Business Phone Number: | 2093922111 |
Business Fax Number: | 2093922850 |
Mailing Address: | 737 W Childs Ave, MERCED |
State: | CA |
Postal Code: | 953416805 |
Phone Number: | 2093831848 |
Fax Number: | 2093843866 |
NPI Enumeration Date: | 11/29/2005 |
NPI Last Update Date: | 12/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA13790 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |