MEDICARE: MR. RICHARD LEE TOLBERT JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333300000X	Emergency Response System Companies	PP0132	TX

General Provider Information

NPI Number	:	1376802264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD LEE TOLBERT JR.

Provider Business Mailing Address
First Line	:	5134 CARDIFF ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-1508
Country	:	US
Telephone Number	:	972-762-0629
Fax Number	:	972-357-7422

Provider Business Practice Location Address
First Line	:	5134 CARDIFF ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-1508
Country	:	US
Telephone Number	:	972-762-0629
Fax Number	:	972-357-7422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	05/11/2012

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