Provider Demographics
NPI:1861932196
Name:TOBY, CHAD
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:TOBY
Suffix:
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 1:14202 ORCHARD FARMS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2056
Mailing Address - Country:US
Mailing Address - Phone:772-501-1131
Mailing Address - Fax:
Practice Address - Street 1:14202 ORCHARD FARMS LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2056
Practice Address - Country:US
Practice Address - Phone:772-501-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor