Healthcare Provider Details

I. General information

NPI: 1316078249
Provider Name (Legal Business Name): STEVEN G TOLBER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

IV. Provider business mailing address

7121 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-2574
  • Fax:
Mailing address:
  • Phone: 505-883-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number74-101
License Number StateNM

VIII. Authorized Official

Name: DR. STEVEN G TOLBER
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 505-883-2574