Provider Demographics
NPI:1578660536
Name:PITTMAN, TONI S (MD)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:S
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:S
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:325 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1360
Mailing Address - Country:US
Mailing Address - Phone:785-505-6162
Mailing Address - Fax:
Practice Address - Street 1:325 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1360
Practice Address - Country:US
Practice Address - Phone:785-505-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431936202K00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology