Basic Information
| Provider Information | |||||||||
| NPI: | 1184695983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TONK | ||||||||
| FirstName: | VIJAY | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | PHD,FACMG | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067434243 | ||||||||
| FaxNumber: | 8067431122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207SC0300X | 2166411 | TX | Y | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Cytogenetic |
ID Information
| ID | Type | State | Issuer | Description | 1186598 | 01 | TX | CAP CERTIFCTN/ACCERDATION | OTHER |