Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | M4594 | TX |
Y | 2081S0010X | Sports Medicine | M4594 | TX |
Y | 213ES0000X | Sports Medicine | M4594 | TX |
NPI | 1447466594 |
---|---|
Provider Name | Allison M Tobola |
First Address | Dallas, TX 75284-6098 |
Second Address | Tyler, TX 75701-4443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 14/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
195628601 | (05) | TX |
752616977021 | TRICARE (01) | TX |
8BC070 | BCBS (01) | TX |