Provider Demographics
NPI:1063406445
Name:JANET M TOBIN MD PA
Entity type:Organization
Organization Name:JANET M TOBIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:941-629-3435
Mailing Address - Street 1:PO BOX 510867
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0867
Mailing Address - Country:US
Mailing Address - Phone:941-629-3435
Mailing Address - Fax:941-629-5250
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:STE 13
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5052
Practice Address - Country:US
Practice Address - Phone:941-629-3435
Practice Address - Fax:941-629-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18220OtherBCBS
FLP00157032Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FLDC2472Medicare ID - Type UnspecifiedRAILROAD GROUP
FL18220OtherBCBS
FLF43158Medicare UPIN