Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G51640 | CA |
NPI | 1043389067 |
---|---|
Provider Name | Dr. Joel Edward Tobiason |
First Address | Santee, CA 92071-3037 |
Second Address | Santee, CA 92071-3037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H58985 | (02) | CA |