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General NPI Number Information
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NPI Number | 1013107853
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Entity Type | Organization
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Legal Business Name | RICHARD SCOTT KOBYLAR J C TANENBAUM DPM PA & ASSOCIATES
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 600 HOSPITAL CIR STE 103
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City | BAY CITY
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State | TX
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Zip | 77414-4772
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Country | US
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Telephone | 979-245-9500
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Fax | 979-323-7370
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Provider Business Mailing Address
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Address Line | 600 HOSPITAL CIR STE 103
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City | BAY CITY
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State | TX
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Zip | 77414-4772
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Country | US
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Telephone | 979-245-9000
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Fax | 979-323-7370
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD SCOTT KOBYLAR
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Credential | DPM
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Telephone | 979-245-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1691
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1691
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License Number State | TX
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