Basic Information
| Provider Information | |||||||||
| NPI: | 1255351565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARTY | ||||||||
| FirstName: | TOBIN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCGOWEN | ||||||||
| OtherFirstName: | TOBIN | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3705 MEDICAL PARKWAY | ||||||||
| Address2: | SUITE 570 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124542554 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3705 MEDICAL PARKWAY | ||||||||
| Address2: | SUITE 570 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124542554 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | M9499 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 142TY | 01 | NC | BCBS | OTHER | 5905457 | 05 | NC | MEDICAID | 7209780 | 01 | AETNA | OTHER | 808487 | 01 | NC | PARTNERS | OTHER | 203924 | 01 | NC | MEDCOST | OTHER | 3810007207 | 05 | WV | MEDICAID | 1255351565 | 05 | VA | MEDICAID |