Individual
THADDEUS REX TOLLESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
J6770
TX
207RI0011X
Interventional Cardiology Physician
Primary
J6770
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154221901
—
TX
01
—
221985502
UNITED HEALTHCARE
TX
01
—
7773430
AETNA
TX
01
—
8G7380
BCBS
TX
01
—
8V5491
BCBS TRINITY
TX
Enumeration date
09/15/2005
Last updated
04/26/2017
Update your record
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