Provider Demographics
NPI:1396089819
Name:TOLLISON, DUBRAVKA MILAS (MD)
Entity type:Individual
Prefix:DR
First Name:DUBRAVKA
Middle Name:MILAS
Last Name:TOLLISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8912 E PINNACLE PEAK RD
Mailing Address - Street 2:STE F9-269
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3659
Mailing Address - Country:US
Mailing Address - Phone:602-751-6118
Mailing Address - Fax:
Practice Address - Street 1:8912 E PINNACLE PEAK RD
Practice Address - Street 2:STE F9-269
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3659
Practice Address - Country:US
Practice Address - Phone:602-751-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine