Provider Demographics
NPI:1104383330
Name:TOOSON, JOHN F IV
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:TOOSON
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-1777
Mailing Address - Country:US
Mailing Address - Phone:419-720-6811
Mailing Address - Fax:419-710-6839
Practice Address - Street 1:1946 N 13TH ST STE 450
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-7257
Practice Address - Country:US
Practice Address - Phone:419-720-6811
Practice Address - Fax:419-720-6809
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0339149Medicaid