Provider Demographics
NPI:1174503106
Name:TOBON, ANDREW A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:A
Last Name:TOBON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7909 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE#110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3425
Mailing Address - Country:US
Mailing Address - Phone:210-614-4544
Mailing Address - Fax:210-679-3724
Practice Address - Street 1:3327 RESEARCH PLZ
Practice Address - Street 2:SUITE # 403
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78235-5155
Practice Address - Country:US
Practice Address - Phone:210-474-7020
Practice Address - Fax:210-679-3734
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3384208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041767701Medicaid
TX82Z704Medicare ID - Type Unspecified
TX041767701Medicaid