Provider Demographics
NPI:1659428704
Name:WIEBE, TIMOTHY MITCHELL (MD, FAANS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MITCHELL
Last Name:WIEBE
Suffix:
Gender:M
Credentials:MD, FAANS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9663
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-9663
Mailing Address - Country:US
Mailing Address - Phone:661-861-0011
Mailing Address - Fax:661-861-1011
Practice Address - Street 1:3545 SAN DIMAS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1605
Practice Address - Country:US
Practice Address - Phone:661-323-1947
Practice Address - Fax:661-323-1904
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53943207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053345991Medicaid
CA00H575380Medicare UPIN
CA1053345991Medicaid