Healthcare Provider Details

I. General information

NPI: 1801893730
Provider Name (Legal Business Name): STUART TOBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S. LIMESTONE, RM L119 UNIVERSITY OF KENTUCKY, KY CLINIC
LEXINGTON KY
40536-0284
US

IV. Provider business mailing address

800 ROSE ST., ROOM C225 UNIVERSITY OF KENTUCKY, DEPT. OF SURGERY
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-3253
  • Fax: 859-323-6840
Mailing address:
  • Phone: 859-323-6346
  • Fax: 859-323-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number18026
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: