Provider Demographics
NPI:1851375414
Name:TOLLEY, RUSSELL C (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:C
Last Name:TOLLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:80 HEALTH PARK DR
Mailing Address - Street 2:STE 270
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9584
Mailing Address - Country:US
Mailing Address - Phone:303-661-1860
Mailing Address - Fax:303-661-1861
Practice Address - Street 1:80 HEALTH PARK DR
Practice Address - Street 2:STE 270
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9584
Practice Address - Country:US
Practice Address - Phone:303-661-1860
Practice Address - Fax:303-661-1861
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO28166207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01281666Medicaid
COC203558Medicare PIN
CO01281666Medicaid