=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629073903
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL W TOMA DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2005
-----------------------------------------------------
Last Update Date | 12/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 444 FOUR STATES DR SUITE 1
-----------------------------------------------------
City | GALENA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66739-4324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-783-4441
-----------------------------------------------------
Fax | 620-783-4090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2546
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64803-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-783-4441
-----------------------------------------------------
Fax | 620-783-4090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | R8F33
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 2330
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 0520529
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------