Provider Demographics
NPI:1740786581
Name:TOLLEY, PHILIP DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:DANIEL
Last Name:TOLLEY
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 1:325 9TH AVE. MAIL STOP#359796
Mailing Address - Street 2:7TH FLOOR CENTER TOWER RM #73.1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-744-2826
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE. MAIL STOP#359796
Practice Address - Street 2:7TH FLOOR CENTER TOWER RM #73.1
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-744-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program