Provider Demographics
NPI:1255365276
Name:TOLAR, ROGER L JR (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:L
Last Name:TOLAR
Suffix:JR
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 1:100 BOURLAND RD STE 170
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3592
Mailing Address - Country:US
Mailing Address - Phone:817-741-2001
Mailing Address - Fax:817-741-2015
Practice Address - Street 1:100 BOURLAND RD STE 170
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3592
Practice Address - Country:US
Practice Address - Phone:817-741-2001
Practice Address - Fax:817-741-2015
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2911207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165367701Medicaid
TXG62865Medicare UPIN
TX165367701Medicaid