Andrew Modic, MD
Internal Medicine in Ridgecrest, CA. Individual provider (NPI-1).
NPI number1063831972
StatusActive
Last updated in NPPESFeb 12, 2019
Details
- NPI
- 1063831972
- Entity type
- Individual (NPI-1)
- Name
- Andrew Modic
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 8, 2014
- Last updated
- Feb 12, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | A155740 | CA | Yes |
| 207R00000X | Internal Medicine | MD.34762 | AL | |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
1111 N China Lake BlvdRidgecrest, CA 93555-3131
Phone 760-499-3855 · Fax 760-499-3870
Mailing address
1081 N China Lake BlvdRidgecrest, CA 93555-3130
Phone 760-499-3855 · Fax 760-499-3870
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