Healthcare Provider Details

I. General information

NPI: 1740285824
Provider Name (Legal Business Name): TOMAS VYBIRAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 PARKWOOD MEDICAL PARK
ELKIN NC
28621-2487
US

IV. Provider business mailing address

PO BOX 249
YADKINVILLE NC
27055-0249
US

V. Phone/Fax

Practice location:
  • Phone: 336-526-7997
  • Fax: 336-526-3537
Mailing address:
  • Phone: 336-679-4963
  • Fax: 336-679-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36845
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36845
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: