Provider Demographics
NPI:1972595692
Name:PERCIVAL, PAUL JOHN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:PERCIVAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:591 MCCRAY ST
Mailing Address - Street 2:STE 221
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-2224
Mailing Address - Country:US
Mailing Address - Phone:831-638-9715
Mailing Address - Fax:831-637-7691
Practice Address - Street 1:591 MCCRAY ST
Practice Address - Street 2:STE 221
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-2224
Practice Address - Country:US
Practice Address - Phone:831-638-9715
Practice Address - Fax:831-637-7691
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-09-29
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Provider Licenses
StateLicense IDTaxonomies
CAG83115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G831151Medicaid
CAG17761Medicare UPIN
CA00G831151Medicare PIN