Basic Information
| Provider Information | |||||||||
| NPI: | 1730197377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOVAR | ||||||||
| FirstName: | J | ||||||||
| MiddleName: | SAMUEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 W 12TH AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | EMPORIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668012587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203432900 | ||||||||
| FaxNumber: | 6203439484 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 12TH AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | EMPORIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668012587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203432900 | ||||||||
| FaxNumber: | 6203439484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-29879 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100425360A | 05 | KS | MEDICAID | 067270 | 01 | KS | MEDICARE PTAN | OTHER |