Provider Demographics
NPI:1093880619
Name:STRATTE, PAUL TRYGVE (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TRYGVE
Last Name:STRATTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:P
Other - Middle Name:TRYG
Other - Last Name:STRATTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2624 EDITH AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3043
Mailing Address - Country:US
Mailing Address - Phone:530-241-3316
Mailing Address - Fax:530-241-6319
Practice Address - Street 1:2624 EDITH AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3043
Practice Address - Country:US
Practice Address - Phone:530-241-3316
Practice Address - Fax:530-241-6319
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75419208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP5241OtherRAILROAD MEDICARE GROUP
CAZZZ78528ZMedicaid
CA34007857OtherRAILROAD MEDICARE
CA00G754190Medicaid
CA00G754190Medicare PIN
CA34007857OtherRAILROAD MEDICARE
CAZZZ78528ZMedicaid