Provider Demographics
NPI:1679804140
Name:CYNTHIA R TOLBERT MD PLLC
Entity type:Organization
Organization Name:CYNTHIA R TOLBERT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-249-5400
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-0792
Mailing Address - Country:US
Mailing Address - Phone:830-249-5400
Mailing Address - Fax:830-249-3778
Practice Address - Street 1:518 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1620
Practice Address - Country:US
Practice Address - Phone:830-249-5400
Practice Address - Fax:830-249-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-24
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4273261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0924458-01Medicaid
TX0924458-01Medicaid