Provider Demographics
NPI:1285603829
Name:TOLLES, STEFFAN ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:STEFFAN
Middle Name:ROSS
Last Name:TOLLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 NW MYHRE RD
Mailing Address - Street 2:SUITE 2360
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8676
Mailing Address - Country:US
Mailing Address - Phone:360-662-1110
Mailing Address - Fax:
Practice Address - Street 1:1780 NW MYHRE RD
Practice Address - Street 2:SUITE 2360
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-662-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA96138OtherL&I
WA1017011Medicaid
AB29185Medicare ID - Type UnspecifiedMEDICARE
WA1017011Medicaid