Provider Demographics
NPI:1619081361
Name:TOBON, ANNA CAVAZOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:CAVAZOS
Last Name:TOBON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:TERESA
Other - Last Name:CAVAZOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:414 NAVARRO ST
Mailing Address - Street 2:STE 1422
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2516
Mailing Address - Country:US
Mailing Address - Phone:210-587-8787
Mailing Address - Fax:210-388-0239
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:STE 1422
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-587-8787
Practice Address - Fax:210-388-0239
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG02892Medicare UPIN