Provider Demographics
NPI:1205839818
Name:HILTY, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:HILTY
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 1:148 CASA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1804
Mailing Address - Country:US
Mailing Address - Phone:805-543-8310
Mailing Address - Fax:805-543-1103
Practice Address - Street 1:148 CASA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1804
Practice Address - Country:US
Practice Address - Phone:805-543-8310
Practice Address - Fax:805-543-1103
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A618850Medicaid
CAA61885Medicare PIN
G69980Medicare UPIN