Provider Demographics
NPI:1982642443
Name:TOMBERLIN, JANICE KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:KELLY
Last Name:TOMBERLIN
Suffix:
Gender:F
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1612 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6913
Practice Address - Country:US
Practice Address - Phone:817-685-4700
Practice Address - Fax:817-685-4595
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH28392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136929001Medicaid
TX136929005Medicaid
TX136929010OtherCSHCN
TX136929012Medicaid
TX8R1570OtherBLUE CROSS OF TEXAS
TX920001139Medicare PIN
TX89W101Medicare PIN
TX136929010OtherCSHCN
TX136929001Medicaid
TX87725KMedicare PIN