MEDICARE: JOHN T TOLLAND MD

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	208C00000X	Colon & Rectal Surgery Physician	ME0050127	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750383733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN T TOLLAND MD

Provider Business Mailing Address
First Line	:	PO BOX 947381
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30394-7381
Country	:	US
Telephone Number	:	386-672-0017
Fax Number	:	386-676-0506

Provider Business Practice Location Address
First Line	:	1185 DUNLAWTON AVE STE 100
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2906
Country	:	US
Telephone Number	:	386-672-0017
Fax Number	:	386-676-0506

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/09/2023

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Directions to “ JOHN T TOLLAND MD” Practice Location

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