Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | J6769 | TX |
NPI | 1003818014 |
---|---|
Provider Name | Evelyn Tobias-Merrill |
First Address | Fort Worth, TX 76109-1377 |
Second Address | Fort Worth, TX 76109-1377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 10/01/2022 |