Mark Anthony Andrew Wimbley

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

G75382 Issued in CA

Practice address

1175 N Euclid St
Anaheim, CA 92801-1938

Phone

(714) 563-1997

NPI assigned

Jul 23, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shalom Medical Group, Inc.

  • Surgery Physician
  • Anaheim, CA
  • NPI 1922024736
  NPD (past)
• Whan Sil Kim, M.D., Inc.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1952477648
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124040068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 N EUCLID ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011938",
            "telephone_number": "714-563-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 N EUCLID ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011938",
            "telephone_number": "714-563-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMBLEY",
        "first_name": "MARK",
        "middle_name": "ANTHONY ANDREW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G75382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Wilson
• Deborah Wilson
• Matthew Langston Wilson
• Sean P Wilson, MD
• Shaelyn Wilson
• Alan David Winans, DDS
• Gina Winans, DPT
• Ashtyn M Winchell
• Windsor Anaheim Healthcare, LTD
• Windstone Addiction Centers, Inc

• General Practice Physician in Anaheim, CA
• Providers in Anaheim, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.