=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114208261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TOBIAS J MORELAND PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2011
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 BAPTIST WAY STE 5C
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 448-227-6950
-----------------------------------------------------
Fax | 850-434-2308
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 95590
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095-0590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-352-9500
-----------------------------------------------------
Fax | 801-352-7976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9106121
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------