Provider Demographics
NPI:1114106853
Name:WILKINS, TIMOTHY WILLIAM (MA, MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:WILKINS
Suffix:
Gender:M
Credentials:MA, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 SUNGLOW DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-6144
Mailing Address - Country:US
Mailing Address - Phone:847-275-5718
Mailing Address - Fax:
Practice Address - Street 1:43563 STATE HIGHWAY 299 E
Practice Address - Street 2:
Practice Address - City:FALL RIVER MILLS
Practice Address - State:CA
Practice Address - Zip Code:96028-9787
Practice Address - Country:US
Practice Address - Phone:530-336-6535
Practice Address - Fax:530-335-5166
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102151207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A102151OtherBLUE SHIELD
CADC206ZOtherMEDICARE PTAN
CA00A102151Medicaid