Provider Demographics
NPI:1750541991
Name:KIRKWOOD, TOBY CARTER (DO)
Entity type:Individual
Prefix:DR
First Name:TOBY
Middle Name:CARTER
Last Name:KIRKWOOD
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 1:4001 PRESTON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-2051
Mailing Address - Country:US
Mailing Address - Phone:281-249-2273
Mailing Address - Fax:281-249-2281
Practice Address - Street 1:4001 PRESTON AVE STE 110
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-2051
Practice Address - Country:US
Practice Address - Phone:281-249-2273
Practice Address - Fax:281-249-2281
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10028460390200000X
TXN6425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2205114-01Medicaid
TXTXB120665Medicare PIN