Provider Demographics
NPI:1649203175
Name:TOLLEY, DOUGLAS GERMOND JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GERMOND
Last Name:TOLLEY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1007 LIVE OAK BLVD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3454
Mailing Address - Country:US
Mailing Address - Phone:530-671-8718
Mailing Address - Fax:530-671-8725
Practice Address - Street 1:1007 LIVE OAK BLVD
Practice Address - Street 2:SUITE B2
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3454
Practice Address - Country:US
Practice Address - Phone:530-671-8718
Practice Address - Fax:530-671-8725
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2014-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG22256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G222560OtherBLUE SHIELD PIN #
CA05D0947254OtherFEDERAL CLIA ID #
CA1649203175Medicaid
CA1649203175Medicaid