Provider Demographics
NPI:1366740060
Name:TOBY A ZIRKLE MD LC
Entity type:Organization
Organization Name:TOBY A ZIRKLE MD LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M,D,/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ZIRKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-892-0135
Mailing Address - Street 1:1151 E 3900 S
Mailing Address - Street 2:SUITE B299
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1216
Mailing Address - Country:US
Mailing Address - Phone:801-892-0135
Mailing Address - Fax:801-266-2362
Practice Address - Street 1:1151 E 3900 S
Practice Address - Street 2:SUITE B299
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1216
Practice Address - Country:US
Practice Address - Phone:801-892-0135
Practice Address - Fax:801-266-2362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT69606951205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000073488Medicare PIN