Provider Demographics
NPI:1083653232
Name:SUNDERMIER, HENRY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:WILLIAM
Last Name:SUNDERMIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 E BIDWELL ST
Mailing Address - Street 2:STE 100
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-735-6070
Mailing Address - Fax:916-983-8591
Practice Address - Street 1:2370 E BIDWELL ST
Practice Address - Street 2:STE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3892
Practice Address - Country:US
Practice Address - Phone:916-735-6070
Practice Address - Fax:916-983-8591
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C409840Medicaid
CA00C409840Medicare ID - Type Unspecified
CA00C409840Medicare PIN
CAA37495Medicare UPIN