Individual
MR. BRYAN TOLLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
506 4TH ST, LA GRANDE, OR 97850-1906
(541) 663-3138
Mailing address
506 4TH ST, LA GRANDE, OR 97850-1906
(541) 663-3138
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS018207
PA
208D00000X
General Practice Physician
510102115
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/07/2012
Last updated
06/02/2020
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