Provider Demographics
NPI:1215920475
Name:TOBKES, ANDREW I (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:I
Last Name:TOBKES
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 1:1009 HARVIN WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955
Mailing Address - Country:US
Mailing Address - Phone:321-632-0497
Mailing Address - Fax:321-631-7746
Practice Address - Street 1:1009 HARVIN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955
Practice Address - Country:US
Practice Address - Phone:321-632-0497
Practice Address - Fax:321-631-7746
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60192207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100007X07OtherRAILROAD MEDICARE
FL4522097OtherAETNA
FLA003OtherTRICARE
FLAF646Medicare PIN
FL25262YMedicare Oscar/Certification
FL100007X07OtherRAILROAD MEDICARE