Healthcare Provider Details

I. General information

NPI: 1467549030
Provider Name (Legal Business Name): PAUL MICHAEL NERZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 COLOMA ST
PLACERVILLE CA
95667-4406
US

IV. Provider business mailing address

3476 BUENA VISTA DR
SHINGLE SPRINGS CA
95682-8813
US

V. Phone/Fax

Practice location:
  • Phone: 916-871-6712
  • Fax: 530-621-7707
Mailing address:
  • Phone: 916-502-1781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number12102
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberG35504
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberC1-0004019
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: