Provider Demographics
NPI:1841685252
Name:GRETCHEN F TOLER MD PLLC
Entity type:Organization
Organization Name:GRETCHEN F TOLER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:TOLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-373-9391
Mailing Address - Street 1:5477 GLEN LAKES DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0946
Mailing Address - Country:US
Mailing Address - Phone:214-373-9391
Mailing Address - Fax:214-373-9303
Practice Address - Street 1:5477 GLEN LAKES DR
Practice Address - Street 2:SUITE 150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0946
Practice Address - Country:US
Practice Address - Phone:214-373-9391
Practice Address - Fax:214-373-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8466261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27021Medicare UPIN