Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 36117 | MN |
N | 208200000X | Surgeon | 36117 | MN |
N | 208600000X | Surgeon | 36117 | MN |
NPI | 1043256357 |
---|---|
Provider Name | Mr. Christopher John Tolan |
First Address | Woodbury, MN 55125 |
Second Address | Woodbury, MN 55125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 16/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286325100 | (05) | MN |
F92300 | (02) |