Healthcare Provider Details

I. General information

NPI: 1467462499
Provider Name (Legal Business Name): TIMOTHY CHARLES GEDNEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27594 FERN PINE WAY
MURRIETA CA
92562-2501
US

IV. Provider business mailing address

27594 FERN PINE WAY
MURRIETA CA
92562-2501
US

V. Phone/Fax

Practice location:
  • Phone: 951-677-2113
  • Fax: 951-461-7493
Mailing address:
  • Phone: 951-677-2113
  • Fax: 951-461-7493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: