MEDICARE: DR. TOLBERT JONES SMALL 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	207R00000X	Internal Medicine Physician	A23282	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740283464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOLBERT JONES SMALL MD

Provider Business Mailing Address
First Line	:	9925 INTERNATIONAL BLVD STE 5
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94603-2558
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9925 INTERNATIONAL BLVD STE 5
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94603-2558
Country	:	US
Telephone Number	:	510-777-1177
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/07/2023

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