Provider Demographics
NPI:1124020102
Name:TOLBOE, H RAND (DPM)
Entity type:Individual
Prefix:DR
First Name:H RAND
Middle Name:
Last Name:TOLBOE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPANOS CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2810
Mailing Address - Country:US
Mailing Address - Phone:209-525-3150
Mailing Address - Fax:209-525-3153
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:SUITE 104
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2810
Practice Address - Country:US
Practice Address - Phone:209-525-3150
Practice Address - Fax:209-525-3153
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2549213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E25490Medicaid
E25490Medicare ID - Type Unspecified
CA000E25490Medicaid