Healthcare Provider Details

I. General information

NPI: 1790799476
Provider Name (Legal Business Name): JOSHUA D TOBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 ROSELAND BLVD 200
TYLER TX
75701-4262
US

IV. Provider business mailing address

PO BOX 130459
TYLER TX
75713-0459
US

V. Phone/Fax

Practice location:
  • Phone: 903-592-6000
  • Fax: 903-363-1540
Mailing address:
  • Phone: 903-531-2500
  • Fax: 903-595-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL9517
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: