Healthcare Provider Details

I. General information

NPI: 1427142819
Provider Name (Legal Business Name): ELIZABETH TOMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 GRANDE BLVD SE VA CLINIC
RIO RANCHO NM
87124-1754
US

IV. Provider business mailing address

1760 GRANDE BLVD SE VA CLINIC
RIO RANCHO NM
87124-1754
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-7200
  • Fax: 505-994-4285
Mailing address:
  • Phone: 505-896-7200
  • Fax: 505-994-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number90124
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: