Provider Demographics
NPI:1821097239
Name:TOBIN, GREGORY A (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:TOBIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 S MOUNT AUBURN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4920
Mailing Address - Country:US
Mailing Address - Phone:573-651-4488
Mailing Address - Fax:573-651-4431
Practice Address - Street 1:300 S MOUNT AUBURN RD
Practice Address - Street 2:STE 100
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4920
Practice Address - Country:US
Practice Address - Phone:573-651-4488
Practice Address - Fax:573-651-4431
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-11-04
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Provider Licenses
StateLicense IDTaxonomies
MOR6H31208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202602801Medicaid
MO25570OtherBCBS OF MO
MO202602801Medicaid
MO25570OtherBCBS OF MO