1790746691 NPI number — JORGE G TOBAR MD

Table of content: JORGE G TOBAR MD (NPI 1790746691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790746691 NPI number — JORGE G TOBAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOBAR
Provider First Name:
JORGE
Provider Middle Name:
G
Provider Name Prefix Text:
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:
1790746691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26726
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78755-0726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-231-5506
Provider Business Mailing Address Fax Number:
512-406-6216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 MEDICAL PKWY BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-7763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-324-4083
Provider Business Practice Location Address Fax Number:
512-324-4717
Provider Enumeration Date:
03/30/2006

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: 207R00000X , with the licence number:  ME 61698 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: N5437 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 216912002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17965 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 216912003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270466800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 216912001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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