Basic Information
Provider Information | |||||||||
NPI: | 1114106853 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WILKINS | ||||||||
FirstName: | TIMOTHY | ||||||||
MiddleName: | WILLIAM | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.A., M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3635 SUNGLOW DR | ||||||||
Address2: |   | ||||||||
City: | REDDING | ||||||||
State: | CA | ||||||||
PostalCode: | 960016144 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8472755718 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 43563 STATE HIGHWAY 299 E | ||||||||
Address2: |   | ||||||||
City: | FALL RIVER MILLS | ||||||||
State: | CA | ||||||||
PostalCode: | 960289787 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5303366535 | ||||||||
FaxNumber: | 5303355166 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/30/2007 | ||||||||
LastUpdateDate: | 11/21/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A102151 | CA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207P00000X | A102151 | CA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 00A102151 | 01 | CA | BLUE SHIELD | OTHER | DC206Z | 01 | CA | MEDICARE PTAN | OTHER | 00A102151 | 05 | CA |   | MEDICAID |