Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 8892 | NV |
NPI | 1053378661 |
---|---|
Provider Name | Timothy Matthew Tolan |
First Address | Henderson, NV 89052-3501 |
Second Address | Henderson, NV 89052-3501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 28/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2018160 | (05) | NV |
F34541 | (02) |