Provider Demographics
NPI:1598385742
Name:TORNBOM, TORA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:TORA
Middle Name:JEAN
Last Name:TORNBOM
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:PO BOX 7445
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 99, UNIT 5024, 35 HCOS/SGGP
Practice Address - Street 2:
Practice Address - City:MISAWA-SHI
Practice Address - State:AOMORI
Practice Address - Zip Code:96319
Practice Address - Country:JP
Practice Address - Phone:315-226-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT5475208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics