Provider Demographics
NPI:1124069828
Name:TOLMAN, MONT B (DO)
Entity type:Individual
Prefix:
First Name:MONT
Middle Name:B
Last Name:TOLMAN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:ID
Mailing Address - Zip Code:83611-1330
Mailing Address - Country:US
Mailing Address - Phone:208-382-4285
Mailing Address - Fax:208-382-5081
Practice Address - Street 1:454 W. ROSEBERRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:DONNELLY
Practice Address - State:ID
Practice Address - Zip Code:83615
Practice Address - Country:US
Practice Address - Phone:208-382-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID11267202Medicare PIN