Provider Demographics
NPI:1578576732
Name:TOLMAN, BRUCE G (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:G
Last Name:TOLMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 ELK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8322
Mailing Address - Country:US
Mailing Address - Phone:208-529-8393
Mailing Address - Fax:208-529-8398
Practice Address - Street 1:1540 ELK CREEK DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8322
Practice Address - Country:US
Practice Address - Phone:208-529-8393
Practice Address - Fax:208-529-8398
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP93213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0025121Medicaid
ID0025121Medicaid
ID1350470Medicare PIN
ID4602220001Medicare NSC