Provider Demographics
NPI:1245220342
Name:THIJSSEN, ANTHONY M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:THIJSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 AIRPARK DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-229-7503
Mailing Address - Fax:530-229-7542
Practice Address - Street 1:2510 AIRPARK DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-229-7503
Practice Address - Fax:530-229-7542
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G871910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00810708OtherMEDICARE RAILROAD
CA00G871910Medicaid
CAI02629Medicare UPIN
CA00G871910Medicare ID - Type UnspecifiedRDG
CA00G871910Medicaid
CA5371630001Medicare NSC