Provider Demographics
NPI:1194114314
Name:TOD TOLAN MD LLC
Entity type:Organization
Organization Name:TOD TOLAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:F
Authorized Official - Last Name:TOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-650-2440
Mailing Address - Street 1:8905 SW NIMBUS AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7136
Mailing Address - Country:US
Mailing Address - Phone:503-372-2740
Mailing Address - Fax:
Practice Address - Street 1:13240 SW PACIFIC HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4805
Practice Address - Country:US
Practice Address - Phone:503-639-6571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty