Provider Demographics
NPI:1174544571
Name:TOBIAS, JUSTIN S (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:S
Last Name:TOBIAS
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 1:420 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2237
Mailing Address - Country:US
Mailing Address - Phone:661-327-1792
Mailing Address - Fax:
Practice Address - Street 1:420 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2237
Practice Address - Country:US
Practice Address - Phone:661-327-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82042207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A820420Medicaid
CAZZZ21367ZMedicare PIN
CAZZZ34009ZMedicare PIN
CA00A820422Medicare PIN
CAZZZ21365ZMedicare PIN
CAI31562Medicare UPIN
CA00A820424Medicare PIN
CA00A820423Medicare PIN
CA00A820420Medicaid
CACD4582Medicare PIN
CAZZZ15999ZMedicare PIN
CAP00284362Medicare PIN
CAZZZ21366ZMedicare PIN
CA00A820421Medicare PIN