Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 30678 | GA |
NPI | 1366454753 |
---|---|
Provider Name | Toncred M Styblo |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322-1013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013943 | UNITED HEALTHCARE (01) | GA |
273522 | BCBS (01) | GA |
515120 | US HEALTHCARE (01) | GA |
D30939001 | (02) | GA |
Y 19880815 | PHCS (01) | GA |