Provider Demographics
NPI:1427142819
Name:TOMAN, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TOMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 GRANDE BLVD SE
Mailing Address - Street 2:VA CLINIC
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1754
Mailing Address - Country:US
Mailing Address - Phone:505-896-7200
Mailing Address - Fax:505-994-4285
Practice Address - Street 1:1760 GRANDE BLVD SE
Practice Address - Street 2:VA CLINIC
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1754
Practice Address - Country:US
Practice Address - Phone:505-896-7200
Practice Address - Fax:505-994-4285
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS5526Medicaid
$$$$$$$$$Medicare PIN
H45887Medicare UPIN