Healthcare Provider Details

I. General information

NPI: 1447822820
Provider Name (Legal Business Name): GRANT WILLIAM TOBIN PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 N HULLEN ST
METAIRIE LA
70001-1982
US

IV. Provider business mailing address

2321 N HULLEN ST
METAIRIE LA
70001-1982
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-7580
  • Fax:
Mailing address:
  • Phone: 504-941-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC8665
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberPLC8665
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: