MEDICARE: DR. PAUL MICHAEL NERZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	12102	WV
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	G35504	CA
3	207QA0401X	Addiction Medicine (Family Medicine) Physician	C1-0004019	DE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080180953	OTHER	CA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1467549030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MICHAEL NERZ MD

Provider Business Mailing Address
First Line	:	3476 BUENA VISTA DR
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-8813
Country	:	US
Telephone Number	:	916-502-1781
Fax Number	:

Provider Business Practice Location Address
First Line	:	2844 COLOMA ST
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4406
Country	:	US
Telephone Number	:	916-871-6712
Fax Number	:	530-621-7707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	11/19/2021

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