Provider Demographics
NPI:1235288481
Name:KATHY A. TOLER, MD, PA
Entity Type:Organization
Organization Name:KATHY A. TOLER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-488-8441
Mailing Address - Street 1:PO BOX 885
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-0885
Mailing Address - Country:US
Mailing Address - Phone:972-991-9950
Mailing Address - Fax:972-991-4026
Practice Address - Street 1:10 MEDICAL PKWY
Practice Address - Street 2:PLAZA 3, STE. 201
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7840
Practice Address - Country:US
Practice Address - Phone:972-488-8441
Practice Address - Fax:972-488-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4054174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0098QVOtherBCBS
TX162294601Medicaid
TXDH2201OtherRR MEDICARE
TXDH2201OtherRR MEDICARE
TX0098QVOtherBCBS