Provider Demographics
NPI:1255871125
Name:TOLBOE FOOT & ANKLE, INC., A PODIATRIC MEDICAL CORPORATION
Entity type:Organization
Organization Name:TOLBOE FOOT & ANKLE, INC., A PODIATRIC MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:RAND
Authorized Official - Last Name:TOLBOE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:209-525-3150
Mailing Address - Street 1:1401 SPANOS COURT
Mailing Address - Street 2:SUITE #104
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2811
Mailing Address - Country:US
Mailing Address - Phone:209-525-3150
Mailing Address - Fax:209-515-3153
Practice Address - Street 1:1401 SPANOS COURT
Practice Address - Street 2:SUITE #104
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2811
Practice Address - Country:US
Practice Address - Phone:209-525-3150
Practice Address - Fax:209-515-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2549213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty