Healthcare Provider Details

I. General information

NPI: 1366602450
Provider Name (Legal Business Name): JEREMY MICHAEL TOLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

1424 SAINT ROCH AVE
NEW ORLEANS LA
70117-8327
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9458
  • Fax: 504-894-5140
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD.203975
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberDR.0053230
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: