Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | J2820 | TX |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | J2820 | TX |
NPI | 1124062385 |
---|---|
Provider Name | Brad S Tolin |
First Address | San Antonio, TX 78216-6905 |
Second Address | San Antonio, TX 78258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 13/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117102704 | (05) | TX |
1895194 | CIGNA (01) | TX |
200042342 | RAILROAD MEDICARE (01) | TX |
4269459 | AETNA (01) | TX |
8B8404 | BCBS (01) | TX |
F22987 | (02) | TX |