Provider Demographics
NPI:1134758246
Name:TOBIN, JOHN PETER III
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PETER
Last Name:TOBIN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 EASTWOOD PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-6209
Mailing Address - Country:US
Mailing Address - Phone:985-502-6609
Mailing Address - Fax:
Practice Address - Street 1:80 VICTORIA LN
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7259
Practice Address - Country:US
Practice Address - Phone:985-502-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6660367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered