Provider Demographics
NPI:1093758047
Name:PAINE, JOEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:E
Last Name:PAINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 DOYLE PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4558
Mailing Address - Country:US
Mailing Address - Phone:707-303-8344
Mailing Address - Fax:707-303-8345
Practice Address - Street 1:500 DOYLE PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-303-8344
Practice Address - Fax:707-303-8345
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036062010207R00000X
CAG89016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13389Medicare UPIN
CAGL683ZMedicare PIN