Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 12102 | WV |
N | 207QA0401X | Family Doctor - Addiction Medicine | C1-0004019 | DE |
Y | 207QA0401X | Family Doctor - Addiction Medicine | G35504 | CA |
NPI | 1467549030 |
---|---|
Provider Name | Dr. Paul Michael Nerz |
First Address | Shingle Springs, CA 95682-8813 |
Second Address | Placerville, CA 95667-4406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080180953 | RAILROAD MEDICARE (01) | CA |
A46378 | (02) | CA |