Provider Demographics
NPI:1811925696
Name:TOSTO, SEBASTIAN T JR (MD)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:T
Last Name:TOSTO
Suffix:JR
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 1:1118 ROSS CLARK CIR STE 210
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3023
Mailing Address - Country:US
Mailing Address - Phone:334-712-3329
Mailing Address - Fax:334-678-2893
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301
Practice Address - Country:US
Practice Address - Phone:334-712-3329
Practice Address - Fax:334-678-2893
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BX226OtherUT BCBSTX
TX8G8313Medicare PIN
TX8G8312Medicare PIN
TXG31405Medicare UPIN