Provider Demographics
NPI:1932736089
Name:TOBUREN, BRYCE (MD)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:TOBUREN
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 1:1 W WINTER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4635
Mailing Address - Country:US
Mailing Address - Phone:833-351-8255
Mailing Address - Fax:
Practice Address - Street 1:1 W WINTER ST STE 200
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-4635
Practice Address - Country:US
Practice Address - Phone:833-351-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3384532084P0804X
OH35.1497692084P0804X
WI86027-202084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry