Individual
GREGORY RICHARD TOLLEFSBOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2701 PRINCE GEORGE AVE, SUITE 100, DESOTO, TX 75115-2045
(972) 296-8888
(972) 780-9550
Mailing address
2701 PRINCE GEORGE AVE, SUITE 100, DESOTO, TX 75115-2045
(972) 296-8888
(972) 780-9550
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02058
TX
363AM0700X
Medical Physician Assistant
PA02058
TX
Other
Enumeration date
04/30/2007
Last updated
11/05/2007
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