Provider Demographics
NPI:1881627693
Name:PALTIN, SHARON (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PALTIN
Suffix:
Gender:F
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:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:LAYTONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95454-0870
Mailing Address - Country:US
Mailing Address - Phone:707-984-6137
Mailing Address - Fax:707-984-7337
Practice Address - Street 1:50 BRANSCOMB RD
Practice Address - Street 2:
Practice Address - City:LAYTONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95454
Practice Address - Country:US
Practice Address - Phone:707-984-6137
Practice Address - Fax:707-984-7337
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC66767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66767OtherCA LICENSE #
CAG66767OtherCA LICENSE #
CAE96230Medicare UPIN