Provider Demographics
NPI:1629008339
Name:SEILER, ANNETTE MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIA
Last Name:SEILER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4722 QUAIL LAKES DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5256
Mailing Address - Country:US
Mailing Address - Phone:209-476-0675
Mailing Address - Fax:209-476-9389
Practice Address - Street 1:4722 QUAIL LAKES DR
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5256
Practice Address - Country:US
Practice Address - Phone:209-476-0675
Practice Address - Fax:209-476-9389
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84474208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A844740Medicaid
CAH95388Medicare UPIN
CA00A844740Medicaid
CA00A844743Medicare PIN