Provider Demographics
NPI:1013918754
Name:TOBEN, CARL EDWARD (DO FAAFP)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:EDWARD
Last Name:TOBEN
Suffix:
Gender:M
Credentials:DO FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445-1601
Mailing Address - Country:US
Mailing Address - Phone:712-364-3304
Mailing Address - Fax:712-364-2539
Practice Address - Street 1:700 E 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1601
Practice Address - Country:US
Practice Address - Phone:712-364-3304
Practice Address - Fax:712-364-2539
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2070888Medicaid
IA42741000001OtherDMERC
IA40995Medicare ID - Type Unspecified
D46469Medicare UPIN