Provider Demographics
NPI:1629125638
Name:TORRALBA, TOBIN R SR (MD)
Entity Type:Individual
Prefix:
First Name:TOBIN
Middle Name:R
Last Name:TORRALBA
Suffix:SR
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 1:3839 COUNTY ROAD 218
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-5708
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-282-4117
Practice Address - Street 1:1409 KINGSLEY AVE
Practice Address - Street 2:STE 6A
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4537
Practice Address - Country:US
Practice Address - Phone:904-264-7517
Practice Address - Fax:904-264-0015
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0062447 00Medicaid
FL26456YMedicare PIN
FL0062447 00Medicaid