Provider Demographics
NPI:1780799460
Name:TOBON, ANDRES (DO)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:TOBON
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 1:405 W BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7401
Mailing Address - Country:US
Mailing Address - Phone:813-662-3376
Mailing Address - Fax:813-662-3009
Practice Address - Street 1:405 W. BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7401
Practice Address - Country:US
Practice Address - Phone:813-662-3376
Practice Address - Fax:813-662-3009
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 7868207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265537300Medicaid
FL13425BMedicare ID - Type Unspecified
FL265537300Medicaid