Provider Demographics
NPI:1932206984
Name:SUTCLIFFE, GAYLE L (MD)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:L
Last Name:SUTCLIFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:125 N LINCOLN ST
Practice Address - Street 2:SUITE G
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3258
Practice Address - Country:US
Practice Address - Phone:707-678-1623
Practice Address - Fax:707-678-0258
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA63673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G636730Medicaid
CA00G636730Medicaid
CA00A636731Medicare PIN
G97033Medicare UPIN