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General NPI Number Information
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NPI Number | 1588172548
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Entity Type | Organization
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Legal Business Name | TIMOTHY M. WIEBE, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 3545 SAN DIMAS ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-1605
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Country | US
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Telephone | 661-323-1947
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Fax | 661-323-1904
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Provider Business Mailing Address
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Address Line | 9304 NICKAM CT
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City | BAKERSFIELD
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State | CA
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Zip | 93311-1819
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Country | US
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Telephone | 661-331-4754
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY MITCHELL WIEBE
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Credential | MD
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Telephone | 661-331-4754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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