Provider Demographics
NPI:1578565438
Name:HILL, ALLAN STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:STEWART
Last Name:HILL
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 1:555 PETALUMA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4224
Mailing Address - Country:US
Mailing Address - Phone:707-829-8426
Mailing Address - Fax:707-829-6675
Practice Address - Street 1:555 PETALUMA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4224
Practice Address - Country:US
Practice Address - Phone:707-829-8426
Practice Address - Fax:707-829-6675
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50413174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680454572OtherTAX ID
CA00G504130Medicaid
CAA51671Medicare UPIN
CA00G504130Medicare ID - Type Unspecified