Provider Demographics
NPI:1033276456
Name:TIMPTON, WANDA GAIL (MD)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:GAIL
Last Name:TIMPTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:WANDA
Other - Middle Name:GAIL
Other - Last Name:TIMPTON-HOLT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5824 HAYNE BLVD
Mailing Address - Street 2:5980 WINCHESTER PARK DRIVE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-1344
Mailing Address - Country:US
Mailing Address - Phone:504-242-4896
Mailing Address - Fax:504-242-4869
Practice Address - Street 1:5824 HAYNE BLVD
Practice Address - Street 2:5980 WINCHESTER PARK DRIVE
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1344
Practice Address - Country:US
Practice Address - Phone:504-242-4896
Practice Address - Fax:504-242-4869
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1357561Medicaid
LAD79766Medicare UPIN
LA51108Medicare ID - Type Unspecified