Provider Demographics
NPI:1902860950
Name:BECHTEL, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BECHTEL
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 1:2800 N CALIFORNIA ST STE 6
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3758
Mailing Address - Country:US
Mailing Address - Phone:209-851-2144
Mailing Address - Fax:209-851-2123
Practice Address - Street 1:2800 N CALIFORNIA ST STE 6
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3758
Practice Address - Country:US
Practice Address - Phone:209-851-2144
Practice Address - Fax:209-851-2123
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94734208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093977191Medicaid
CA1902860950Medicaid
CAA94734OtherMEDICAL LICENSE