Individual
DERRICK EDWARD TOBIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
200 E CHESTNUT ST STE 303, LOUISVILLE, KY 40202-1831
(502) 629-5552
(502) 629-3132
Mailing address
PO BOX 766351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39298
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000515641
ANTHEM - NINPTSPEC
—
01
—
000028412O
HUMANA - NIS
KY
01
—
0752823
CIGNA - NIS
KY
01
—
085911
SIHO - NIS
KY
05
—
200803120
—
IN
01
—
2648495000
PAD - NINPTSPEC
—
01
—
50014705
PASSPORT - NINPTSPEC
—
05
—
64105570
—
KY
01
—
P00460518
RR-MCR-KY - NIS
KY
Enumeration date
02/09/2006
Last updated
07/21/2016
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