Provider Demographics
NPI:1629340849
Name:TOLSON, JOHN III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TOLSON
Suffix:III
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 1:1604 W PINHOOK RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3732
Mailing Address - Country:US
Mailing Address - Phone:337-232-4349
Mailing Address - Fax:337-232-4791
Practice Address - Street 1:1604 W PINHOOK RD
Practice Address - Street 2:SUITE 309
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3732
Practice Address - Country:US
Practice Address - Phone:337-232-4349
Practice Address - Fax:337-232-4791
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.010326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist