MEDICARE: DR. ROGELIO TAN TOH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C43085	CA

General Provider Information

NPI Number	:	1114998077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGELIO TAN TOH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 12089
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92423-2089
Country	:	US
Telephone Number	:	909-335-4148
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 N RIVERSIDE AVE
Second Line	:	SUITE 240
City	:	RIALTO
State	:	CA
Zip	:	92376-8071
Country	:	US
Telephone Number	:	909-421-2700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	02/18/2009

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