Provider Demographics
NPI:1477992691
Name:TOBIN, KIM (MT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:TOBIN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BRENT CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9060
Mailing Address - Country:US
Mailing Address - Phone:225-302-5363
Mailing Address - Fax:225-302-5363
Practice Address - Street 1:11 BRENT CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9060
Practice Address - Country:US
Practice Address - Phone:225-302-5363
Practice Address - Fax:225-302-5363
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACLP.202906-GEN246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist