Healthcare Provider Details

I. General information

NPI: 1003813650
Provider Name (Legal Business Name): ROBERT THEODORE TOBORG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BROOKVIEW HILLS BLVD STE 204
WINSTON-SALEM NC
27103-5661
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-774-3740
  • Fax: 336-774-3780
Mailing address:
  • Phone: 336-718-4820
  • Fax: 704-384-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9901057
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: