Provider Demographics
NPI:1730227356
Name:GREGG M. TOBIN, MD, PC
Entity type:Organization
Organization Name:GREGG M. TOBIN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:MORAN
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-842-1612
Mailing Address - Street 1:PO BOX 651
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-0651
Mailing Address - Country:US
Mailing Address - Phone:605-842-1612
Mailing Address - Fax:605-842-3837
Practice Address - Street 1:825 E 8TH ST STE 202
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2633
Practice Address - Country:US
Practice Address - Phone:605-842-1612
Practice Address - Fax:605-842-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0195208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4999933OtherWELLMARK BC/BS
NE=========13Medicaid
4999933OtherWELLMARK BC/BS
NE=========13Medicaid
SDS5935Medicare PIN