Provider Demographics
NPI:1043408693
Name:JILL E. STOCKER, D.O. PC
Entity Type:Organization
Organization Name:JILL E. STOCKER, D.O. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:STOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:530-755-1500
Mailing Address - Street 1:1166 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3407
Mailing Address - Country:US
Mailing Address - Phone:530-751-1500
Mailing Address - Fax:530-751-1616
Practice Address - Street 1:1166 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3407
Practice Address - Country:US
Practice Address - Phone:530-751-1500
Practice Address - Fax:530-751-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0460436Medicaid
CA0460436Medicaid
CAH74018Medicare UPIN