MEDICARE: ANDRES JOSE JADUE TOBAR MD

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	57.246254	OH

General Provider Information

NPI Number	:	1265911234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRES JOSE JADUE TOBAR MD

Provider Business Mailing Address
First Line	:	280 SILVER MAPLE RDG
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25306-1122
Country	:	US
Telephone Number	:	216-466-4250
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 SILVER MAPLE RDG
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25306-1122
Country	:	US
Telephone Number	:	216-466-4250
Fax Number	:

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

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	02/11/2022

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