Healthcare Provider Details

I. General information

NPI: 1629575865
Provider Name (Legal Business Name): MR. ONESMUS KIPROTICH TOO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 FILLINGIM ST
MOBILE AL
36617-2238
US

IV. Provider business mailing address

6650 COTTAGE HILL RD APT 1002
MOBILE AL
36695-3750
US

V. Phone/Fax

Practice location:
  • Phone: 251-470-5805
  • Fax:
Mailing address:
  • Phone: 251-377-6816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-126681
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: