Provider Demographics
NPI:1538153713
Name:BRAR, PARDEEP S (MD,)
Entity type:Individual
Prefix:DR
First Name:PARDEEP
Middle Name:S
Last Name:BRAR
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:PARDEEP
Other - Middle Name:S
Other - Last Name:BRAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD INC
Mailing Address - Street 1:PO BOX 3346
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95353-3346
Mailing Address - Country:US
Mailing Address - Phone:209-484-9855
Mailing Address - Fax:
Practice Address - Street 1:803 COFFEE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4227
Practice Address - Country:US
Practice Address - Phone:209-624-8780
Practice Address - Fax:209-208-3292
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54142207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD069AOtherMEDICARE GROUP PTAN
CAEP663ZOtherMEDICARE INDIVIDUAL PTAN