Provider Demographics
NPI:1508831843
Name:TOLEDO, ANTONIO TIMBOL (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:TIMBOL
Last Name:TOLEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W 7TH AVE
Mailing Address - Street 2:P O BOX 426
Mailing Address - City:FLOODWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55736-0426
Mailing Address - Country:US
Mailing Address - Phone:218-476-2221
Mailing Address - Fax:218-476-2965
Practice Address - Street 1:126 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLOODWOOD
Practice Address - State:MN
Practice Address - Zip Code:55736-0426
Practice Address - Country:US
Practice Address - Phone:218-476-2221
Practice Address - Fax:218-476-2965
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51G14OtherMPIN
MN51G14OtherMPIN