Healthcare Provider Details

I. General information

NPI: 1134112626
Provider Name (Legal Business Name): JEFFREY ROBERT TOMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FOURTH AVE SUITE 510
SAN DIEGO CA
92103-2116
US

IV. Provider business mailing address

4060 FOURTH AVE SUITE 510
SAN DIEGO CA
92103-2116
US

V. Phone/Fax

Practice location:
  • Phone: 619-686-4011
  • Fax: 619-686-4041
Mailing address:
  • Phone: 619-686-4011
  • Fax: 619-686-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL8980
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberL8980
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA83995
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA83995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: