Provider Demographics
NPI:1477570810
Name:DE TOLEDO, JOHN C
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:DE TOLEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOAO
Other - Middle Name:
Other - Last Name:DE TOLEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-8321
Mailing Address - Country:US
Mailing Address - Phone:806-743-2391
Mailing Address - Fax:806-743-5687
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-8321
Practice Address - Country:US
Practice Address - Phone:806-743-2391
Practice Address - Fax:806-743-5687
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN93612084E0001X, 2084N0400X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009737Medicaid
SCQ0024NMedicaid
TX202479601Medicaid
NC198275OtherMEDCOST
VA1477570810Medicaid
NC809210OtherPARTNERS
NC144PNOtherBCBS
NC5907931Medicaid
FL3791921-00Medicaid
NC4122695OtherAETNA
WV3810009737Medicaid
SCQ0024NMedicaid
FL28340Medicare PIN
NC809210OtherPARTNERS
NC144PNOtherBCBS