Provider Demographics
NPI:1750383733
Name:TOLLAND, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:TOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 947381
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7381
Mailing Address - Country:US
Mailing Address - Phone:386-672-0017
Mailing Address - Fax:386-676-0506
Practice Address - Street 1:1185 DUNLAWTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2906
Practice Address - Country:US
Practice Address - Phone:386-672-0017
Practice Address - Fax:386-676-0506
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0050127208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041825100Medicaid
FLE59505Medicare UPIN
FL041825100Medicaid