Provider Demographics
NPI:1326168386
Name:TOMOYE, EDWARD O (DO, MA)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:O
Last Name:TOMOYE
Suffix:
Gender:M
Credentials:DO, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 N BURLESON BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8458
Mailing Address - Country:US
Mailing Address - Phone:817-921-1886
Mailing Address - Fax:
Practice Address - Street 1:7208 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8693
Practice Address - Country:US
Practice Address - Phone:178-921-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58-002199261Q00000X
TXN9785207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB144822Medicare PIN