Provider Demographics
NPI:1235980772
Name:TONER, DEMITRA DAWN
Entity Type:Individual
Prefix:
First Name:DEMITRA
Middle Name:DAWN
Last Name:TONER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 COUNTRY OAKS ST
Mailing Address - Street 2:
Mailing Address - City:BRAZORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77422-8394
Mailing Address - Country:US
Mailing Address - Phone:979-716-7453
Mailing Address - Fax:
Practice Address - Street 1:5819 HWY 6
Practice Address - Street 2:SWT 360
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459
Practice Address - Country:US
Practice Address - Phone:832-514-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty