1275511370 NPI number — DR. JOHN CAREY TOMBERLIN MD

Table of content: DR. JOHN CAREY TOMBERLIN MD (NPI 1275511370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275511370 NPI number — DR. JOHN CAREY TOMBERLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOMBERLIN
Provider First Name:
JOHN
Provider Middle Name:
CAREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275511370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1928
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAINBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39818-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-684-3655
Provider Business Mailing Address Fax Number:
334-684-3312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 ANDREWS AVE
Provider Second Line Business Practice Location Address:
LYSTER ARMY HEALTH CLINIC
Provider Business Practice Location Address City Name:
FORT RUCKER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-255-7387
Provider Business Practice Location Address Fax Number:
334-255-7716
Provider Enumeration Date:
01/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME60438 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 10925 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)