Provider Demographics
NPI:1497790810
Name:SILL, TIMOTHY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:SILL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 RIO LINDA DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-1725
Mailing Address - Country:US
Mailing Address - Phone:661-428-0897
Mailing Address - Fax:661-324-3937
Practice Address - Street 1:2619 F ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1815
Practice Address - Country:US
Practice Address - Phone:661-861-0011
Practice Address - Fax:661-861-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3519213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT88729Medicare UPIN
CA000E35190Medicare PIN