Healthcare Provider Details

I. General information

NPI: 1679691497
Provider Name (Legal Business Name): ANNEMARIE PADDOCK HARGADON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E GRANT AVE
WINTERS CA
95694-1842
US

IV. Provider business mailing address

1210 MARINA CIR
DAVIS CA
95616-2736
US

V. Phone/Fax

Practice location:
  • Phone: 530-795-1110
  • Fax:
Mailing address:
  • Phone: 530-753-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG71986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: