Basic Information
| Provider Information | |||||||||
| NPI: | 1629158019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARBERD | ||||||||
| FirstName: | TOBE | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 368 | ||||||||
| Address2: | 219 E. JOHNSON AVE. | ||||||||
| City: | CHELAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988160368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096822511 | ||||||||
| FaxNumber: | 5096822515 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 S APPLE BLOSSOM DR | ||||||||
| Address2: | |||||||||
| City: | CHELAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988168810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096826000 | ||||||||
| FaxNumber: | 5096826192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60078996 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2003430 | 05 | WA | MEDICAID |