Provider Demographics
NPI:1205876711
Name:TOOTE, PAUL URBAN (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:URBAN
Last Name:TOOTE
Suffix:
Gender:M
Credentials:DO
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 8549
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76124-0549
Mailing Address - Country:US
Mailing Address - Phone:817-451-4208
Mailing Address - Fax:817-496-5151
Practice Address - Street 1:115 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2105
Practice Address - Country:US
Practice Address - Phone:903-885-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2841207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179776310Medicaid
TX0076NSOtherBLUE CROSS BLUE SHIELD
TX179776306Medicaid
TX8U5864OtherBLUE CROSS BLUE SHILED
TX179776310Medicaid
TX8J6113Medicare PIN
TX325656YLLYMedicare PIN
TX8J3841Medicare PIN
TX325656YKN5Medicare PIN
TX179776334Medicare PIN
TX612548Medicare PIN