Provider Demographics
NPI:1124324447
Name:LUIZ TOLEDO MD PA
Entity type:Organization
Organization Name:LUIZ TOLEDO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-377-0050
Mailing Address - Street 1:4255 BRYANT IRVIN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4233
Mailing Address - Country:US
Mailing Address - Phone:817-377-0050
Mailing Address - Fax:817-377-0054
Practice Address - Street 1:4255 BRYANT IRVIN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4233
Practice Address - Country:US
Practice Address - Phone:817-377-0050
Practice Address - Fax:817-377-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG87632086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB140044Medicare PIN