Individual
MR. THOMAS WAYNE DOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CO
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CO001146
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200114
CMS NUMBER
CA
01
—
XA0011460
MEDI-CAL PROVIDER#
CA
Enumeration date
07/31/2009
Last updated
03/10/2014
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