Healthcare Provider Details

I. General information

NPI: 1174580617
Provider Name (Legal Business Name): GARY TOBIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 TEQUESTA DR SUITE 102
TEQUESTA FL
33469-3087
US

IV. Provider business mailing address

399 TEQUESTA DR SUITE 102
TEQUESTA FL
33469-3087
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-5533
  • Fax: 561-747-6599
Mailing address:
  • Phone: 561-747-5533
  • Fax: 561-747-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME44113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: