Provider Demographics
NPI:1356323521
Name:TAIT, ANNE E (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:TAIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 HILL RD E STE C
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5100
Mailing Address - Country:US
Mailing Address - Phone:707-263-3520
Mailing Address - Fax:707-263-3570
Practice Address - Street 1:5150 HILL RD E STE C
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5100
Practice Address - Country:US
Practice Address - Phone:707-263-3520
Practice Address - Fax:707-263-3570
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0G62640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28485ZOtherBLUE SHIELD
CA00G626401Medicare ID - Type Unspecified
E25166Medicare UPIN