Provider Demographics
NPI:1851358030
Name:TOLSON, DANIEL JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JACOB
Last Name:TOLSON
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 1:22601 138TH AVE E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7215
Mailing Address - Country:US
Mailing Address - Phone:580-919-0601
Mailing Address - Fax:
Practice Address - Street 1:17615 85TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-1902
Practice Address - Country:US
Practice Address - Phone:425-998-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061661A208000000X, 2080P0006X
WA60954756208000000X, 2080P0006X
TXV51382080P0006X
ID40714692080P0006X
AK2305082080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics