MEDICARE: DR. ROBERT WYNN TONKS 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	207RI0011X	Interventional Cardiology Physician	M-15241	ID

General Provider Information

NPI Number	:	1902197866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WYNN TONKS MD

Provider Business Mailing Address
First Line	:	775 POLE LINE RD W STE 112
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	775 POLE LINE RD W STE 112
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5819
Country	:	US
Telephone Number	:	208-814-1000
Fax Number	:

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

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	06/03/2020

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