Healthcare Provider Details

I. General information

NPI: 1306348917
Provider Name (Legal Business Name): ELIAS Z TOHME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 08/19/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 DOOLITTLE DR # 57706
ELLSWORTH AFB SD
57706-4821
US

IV. Provider business mailing address

2900 DOOLITTLE DR. ELLSWORTH AFB
BOX ELDER SD
57706
US

V. Phone/Fax

Practice location:
  • Phone: 605-385-3002
  • Fax:
Mailing address:
  • Phone: 605-385-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: