Provider Demographics
NPI:1629259437
Name:STEFFAN R. TOLLES, MD
Entity Type:Organization
Organization Name:STEFFAN R. TOLLES, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEFFAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOLLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-662-1110
Mailing Address - Street 1:1780 NW MYHRE RD STE 2360
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8676
Mailing Address - Country:US
Mailing Address - Phone:360-662-1110
Mailing Address - Fax:360-662-0826
Practice Address - Street 1:1780 NW MYHRE RD STE 2360
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-662-1110
Practice Address - Fax:360-662-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017011Medicaid
WAA07029Medicare UPIN
WA1017011Medicaid