Provider Demographics
NPI:1588656730
Name:ANDERSON, TOBY ERIC (MD)
Entity Type:Individual
Prefix:MR
First Name:TOBY
Middle Name:ERIC
Last Name:ANDERSON
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 1:9705 OGLESBY RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-4304
Mailing Address - Country:US
Mailing Address - Phone:901-338-2188
Mailing Address - Fax:901-872-4188
Practice Address - Street 1:9705 OGLESBY RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-4304
Practice Address - Country:US
Practice Address - Phone:901-338-2188
Practice Address - Fax:901-872-4188
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 37824207Q00000X
ARE-3513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3888454Medicaid
TN3888455Medicaid
TN4198103OtherBCBS
TN1510304Medicaid
TN3888454Medicaid
TN3888455Medicaid
TN1510304Medicaid
TN38884544Medicare PIN