Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD22161 | TN |
N | 2080P0204X | Pediatric Emergency Doctor | MD22161 | TN |
NPI | 1144259920 |
---|---|
Provider Name | Dr. Larry Michael Toffoletto |
First Address | Knoxville, TN 37909-2675 |
Second Address | Morristown, TN 37813-2837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 08/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4100810 | BLUE CROSS (01) | TN |
5440528 | (05) | TN |
64096969 | (05) | KY |