Provider Demographics
NPI:1336126374
Name:CLINE, JERRY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:MICHAEL
Last Name:CLINE
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 1:138 S ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3636
Mailing Address - Country:US
Mailing Address - Phone:707-449-8996
Mailing Address - Fax:707-469-6705
Practice Address - Street 1:138 S ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3636
Practice Address - Country:US
Practice Address - Phone:707-449-8996
Practice Address - Fax:707-469-6705
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11423207Q00000X
CAA106005207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS13448OtherPHARMACY/CDS
CA1306011374Medicaid
CA1306011374Medicaid