Provider Demographics
NPI:1780697045
Name:STOCKER, JILL ELISE (DO)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ELISE
Last Name:STOCKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-751-1500
Mailing Address - Fax:530-751-1616
Practice Address - Street 1:1166 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-751-1500
Practice Address - Fax:530-751-1616
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX89280Medicaid
CAH74018Medicare UPIN
CAZZZ32201ZMedicare ID - Type Unspecified