Healthcare Provider Details

I. General information

NPI: 1154525616
Provider Name (Legal Business Name): JOHN TOBY IMM B.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 PALAFOX PL
PENSACOLA FL
32502-5629
US

IV. Provider business mailing address

113 PALAFOX PL
PENSACOLA FL
32502-5629
US

V. Phone/Fax

Practice location:
  • Phone: 850-380-8184
  • Fax: 850-434-1830
Mailing address:
  • Phone: 850-380-8184
  • Fax: 850-434-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: