Healthcare Provider Details

I. General information

NPI: 1205021714
Provider Name (Legal Business Name): BRUCE G. TOLMAN, DMP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

IV. Provider business mailing address

1540 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-8393
  • Fax:
Mailing address:
  • Phone: 208-529-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE G TOLMAN
Title or Position: OWNER
Credential: DMP
Phone: 208-529-8393