Provider Demographics
NPI:1831445949
Name:TIMS, ALLISON M (DO)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:M
Last Name:TIMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1755 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1721
Practice Address - Country:US
Practice Address - Phone:302-478-8005
Practice Address - Fax:530-241-1174
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A15887207Q00000X
CO0052863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO025493OtherKAISER COMMERCIAL NUMBER
CO74124846Medicaid
CO025493OtherKAISER COMMERCIAL NUMBER