=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679804140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYNTHIA R TOLBERT MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2010
-----------------------------------------------------
Last Update Date | 01/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 518 N MAIN ST
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-249-5400
-----------------------------------------------------
Fax | 830-249-3778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 792
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-0792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-249-5400
-----------------------------------------------------
Fax | 830-249-3778
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CYNTHIA R TOLBERT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 830-249-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | K4273
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------