| Gary D Wikholm, Md A Pc | |
|
247 W Harvard Blvd Santa Paula CA 93060-3223 | |
| (805) 525-0907 | |
| (805) 933-3392 |
| Full Name | Gary D Wikholm, Md A Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 247 W Harvard Blvd, Santa Paula, California |
| Authorized Official Name and Position | Agi Kessler (MANAGER) |
| Authorized Official Contact | 8055250907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary D Wikholm, Md A Pc 247 W Harvard Blvd Santa Paula CA 93060-3223 Ph: (805) 525-0907 | Gary D Wikholm, Md A Pc 247 W Harvard Blvd Santa Paula CA 93060-3223 Ph: (805) 525-0907 |
| NPI Number | 1053417725 |
|---|---|
| Provider Enumeration Date | 09/16/2006 |
| Last Update Date | 12/08/2011 |
| Medicare PECOS PAC ID | 2769418334 |
|---|---|
| Medicare Enrollment ID | O20050714000657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053417725 | NPI | - | NPPES |
| GR0085000 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gary D Wikholm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861598526 PECOS PAC ID: 9234231176 Enrollment ID: I20080108000884 |
| Provider Name | Evelyn H Dowell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629054929 PECOS PAC ID: 0446482350 Enrollment ID: I20140408001147 |
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