Provider Demographics
NPI:1215904610
Name:TOBIN, TIMOTHY M (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:TOBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 HOLLYBROOK
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605
Mailing Address - Country:US
Mailing Address - Phone:903-757-6042
Mailing Address - Fax:903-232-8226
Practice Address - Street 1:2901 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5128
Practice Address - Country:US
Practice Address - Phone:903-757-6042
Practice Address - Fax:903-232-8226
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044071101Medicaid
TX110204439OtherRR MEDICARE
TXF31568Medicare UPIN