Provider Demographics
NPI:1467446773
Name:TOLLERSON, JOHN MARK (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:TOLLERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:160 HERITAGE WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3127
Mailing Address - Country:US
Mailing Address - Phone:406-752-8433
Mailing Address - Fax:406-756-6768
Practice Address - Street 1:160 HERITAGE WAY STE 202
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3127
Practice Address - Country:US
Practice Address - Phone:406-752-8433
Practice Address - Fax:406-756-6768
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002022207Q00000X
MT11207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine