Provider Demographics
NPI:1811984859
Name:ARNOLD, JERRY P (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:P
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:681 MAIN STREET STE 105
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-626-1166
Mailing Address - Fax:530-626-3826
Practice Address - Street 1:1100 MARSHALL WAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-622-1441
Practice Address - Fax:530-626-3826
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC352332085B0100X, 2085N0700X, 2085N0904X, 2085R0202X, 2085R0204X, 2085R0205X, 2085U0001X, 2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053460Medicaid
CAGR0053460Medicaid
CA00C352330Medicare PIN