Healthcare Provider Details

I. General information

NPI: 1164517652
Provider Name (Legal Business Name): JERROLD E NADLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2182 HIGHWAY 4
ARNOLD CA
95223
US

IV. Provider business mailing address

PO BOX 1372
MURPHYS CA
95247-1372
US

V. Phone/Fax

Practice location:
  • Phone: 209-795-4193
  • Fax:
Mailing address:
  • Phone: 209-728-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG22714
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG22714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: