Provider Demographics
NPI:1609874510
Name:WIRTH, STEVEN C (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:WIRTH
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 1:333 LAWS AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6540
Mailing Address - Country:US
Mailing Address - Phone:707-468-1010
Mailing Address - Fax:707-462-7532
Practice Address - Street 1:721 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5300
Practice Address - Country:US
Practice Address - Phone:707-462-3300
Practice Address - Fax:707-462-3303
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G079607OtherMEDICARE
CA00G079607OtherMEDICARE