Provider Demographics
NPI:1396788196
Name:HARRIS, TOBEY JR (MD)
Entity type:Individual
Prefix:
First Name:TOBEY
Middle Name:
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 CASTLE PINES DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4456
Mailing Address - Country:US
Mailing Address - Phone:636-227-5708
Mailing Address - Fax:636-227-5708
Practice Address - Street 1:901 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3127
Practice Address - Country:US
Practice Address - Phone:636-239-8011
Practice Address - Fax:636-390-7296
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6G56207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124884OtherBLUE CROSS
MO426403OtherHEALTHLINK
MO930088678OtherRAILROAD MEDICARE
MO947071631OtherMERCYHEALTH
MO204620611Medicaid
MO124884OtherBLUE CROSS
MOC44833Medicare UPIN