Provider Demographics
NPI:1376802264
Name:TOLBERT, RICHARD LEE JR
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:TOLBERT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5134 CARDIFF ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-1508
Mailing Address - Country:US
Mailing Address - Phone:972-762-0629
Mailing Address - Fax:972-357-7422
Practice Address - Street 1:5134 CARDIFF ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-1508
Practice Address - Country:US
Practice Address - Phone:972-762-0629
Practice Address - Fax:972-357-7422
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPP0132333300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies