Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11423 | NV |
Y | 207VX0000X | Obstetrician | A106005 | CA |
NPI | 1336126374 |
---|---|
Provider Name | Dr. Jerry Michael Cline |
First Address | Vacaville, CA 95688-3636 |
Second Address | Vacaville, CA 95688-3636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1306011374 | (05) | CA |
BC7829344 | DEA (01) | NV |
CS13448 | PHARMACY/CDS (01) | NV |