Provider Demographics
NPI:1568652899
Name:ALLIGOOD, TOBY RAY (MD)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:RAY
Last Name:ALLIGOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:916 HIDDEN JEWEL LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4225
Mailing Address - Country:US
Mailing Address - Phone:919-453-0031
Mailing Address - Fax:
Practice Address - Street 1:10931 RAVEN RIDGE RD
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6499
Practice Address - Country:US
Practice Address - Phone:919-870-6600
Practice Address - Fax:919-870-1610
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20868207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC202440AMedicare PIN
P00464699Medicare PIN