Healthcare Provider Details

I. General information

NPI: 1821097239
Provider Name (Legal Business Name): GREGORY A TOBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S MOUNT AUBURN RD STE 100
CAPE GIRARDEAU MO
63703-4920
US

IV. Provider business mailing address

300 S MOUNT AUBURN RD STE 100
CAPE GIRARDEAU MO
63703-4920
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-4488
  • Fax: 573-651-4431
Mailing address:
  • Phone: 573-651-4488
  • Fax: 573-651-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberR6H31
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: