MEDICARE: J. B. WILMETH, M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A21115	CA

General Provider Information

NPI Number	:	1073708715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. B. WILMETH, M.D., INC.

Provider Business Mailing Address
First Line	:	223 E THOUSAND OAKS BOULEVARD
Second Line	:	SUITE 405
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5803
Country	:	US
Telephone Number	:	805-497-3954
Fax Number	:	818-475-1581

Provider Business Practice Location Address
First Line	:	233 E THOUSAND OAKS BOULEVARD
Second Line	:	SUITE 405
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5803
Country	:	US
Telephone Number	:	805-497-3954
Fax Number	:	818-475-1581

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JO BRICE WILMETH
Credential	:	M.D.
Telephone Number	:	805-497-3954

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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