Provider Demographics
NPI:1366462095
Name:CURTIS, ALTON L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALTON
Middle Name:L
Last Name:CURTIS
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 1:632 W GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695
Mailing Address - Country:US
Mailing Address - Phone:530-666-1631
Mailing Address - Fax:
Practice Address - Street 1:632 W GIBSON RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:530-666-1631
Practice Address - Fax:530-661-2410
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34097207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00745221OtherMEDICARE RAILROAD CARRIER
CA00C340970Medicaid
CA00C340970OtherBLUE SHIELD
CAP00745221OtherMEDICARE RAILROAD CARRIER
CA00C340970OtherBLUE SHIELD
CA00C340970Medicare ID - Type Unspecified