Provider Demographics
NPI:1134348816
Name:TIMOTHY M. TOLAN, M.D., INC.
Entity type:Organization
Organization Name:TIMOTHY M. TOLAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-735-1400
Mailing Address - Street 1:5785 S. FORT APACHE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-735-1400
Mailing Address - Fax:
Practice Address - Street 1:5785 S. FORT APACHE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-735-1400
Practice Address - Fax:702-688-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF34541Medicare UPIN