Provider Demographics
NPI:1235289208
Name:TOBAN, MOHAMED MOATAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:MOATAZ
Last Name:TOBAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:MOATAZ
Other - Last Name:TOBAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2057 FOREST RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-8256
Mailing Address - Country:US
Mailing Address - Phone:931-446-5005
Mailing Address - Fax:615-246-3964
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-412-5122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98765207RC0200X, 207RS0012X
FLME 98765207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003136700Medicaid
FLP00921814OtherRAILROAD MEDICARE
FL14AA3OtherBCBS OF FL
FLP00921814OtherRAILROAD MEDICARE