MEDICARE: JONATHAN LANE TOBEY 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	207X00000X	Orthopaedic Surgery Physician	E-14169	AR

General Provider Information

NPI Number	:	1558749028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN LANE TOBEY MD

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DR STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4393
Country	:	US
Telephone Number	:	479-709-7000
Fax Number	:	479-709-7005

Provider Business Practice Location Address
First Line	:	1506 DODSON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-5128
Country	:	US
Telephone Number	:	479-709-7000
Fax Number	:	479-709-7005

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	10/10/2022

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