Provider Demographics
NPI:1790746691
Name:TOBAR, JORGE G (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:G
Last Name:TOBAR
Suffix:
Gender:M
Credentials:MD
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 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-231-5506
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PKWY BLDG B
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7763
Practice Address - Country:US
Practice Address - Phone:512-324-4083
Practice Address - Fax:512-324-4717
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61698207R00000X
TXN5437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216912002Medicaid
FL17965OtherBLUE CROSS
TX216912003Medicaid
FL270466800Medicaid
TX216912001Medicaid
TXTXB113957Medicare PIN
TX216912003Medicaid
TXTXB147772Medicare PIN
FLF40244Medicare UPIN
TX216912001Medicaid
TXP01154989Medicare PIN
TXTXB147786Medicare PIN