Provider Demographics
NPI:1295915536
Name:ENNISS, TOBY MERRILL (MD)
Entity type:Individual
Prefix:DR
First Name:TOBY
Middle Name:MERRILL
Last Name:ENNISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:30 N. 1900 EAST, MREB 307
Mailing Address - Street 2:UNIVERSITY OF UTAH SCHOOL OF MEDICINE, DEPT. OF SURGERY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-585-7280
Mailing Address - Fax:801-587-9370
Practice Address - Street 1:30 N. 1900 EAST, MREB 307
Practice Address - Street 2:UNIVERSITY OF UTAH SCHOOL OF MEDICINE, DEPT. OF SURGERY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132
Practice Address - Country:US
Practice Address - Phone:801-585-7280
Practice Address - Fax:801-587-9370
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7643802-1205208600000X, 2086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7643802-8905OtherSTATE CONTROLLED SUBSTANCE NUMBER
UT7643802-1205OtherSTATE MEDICAL LICENSE
FE1070731OtherFEDERAL DEA #
UT7643802-8905OtherSTATE CONTROLLED SUBSTANCE NUMBER