Provider Demographics
NPI:1396827507
Name:TOELLE, STANLEY A (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:A
Last Name:TOELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 LINCOLN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2476
Mailing Address - Country:US
Mailing Address - Phone:208-667-5483
Mailing Address - Fax:208-667-7062
Practice Address - Street 1:1607 LINCOLN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2476
Practice Address - Country:US
Practice Address - Phone:208-667-5483
Practice Address - Fax:208-667-7062
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5638207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000103600Medicaid
ID000103600Medicaid
1123320Medicare PIN