Individual
CRAIG WALLIS TOLLESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2187 N VICKEY ST, FLAGSTAFF, AZ 86004-6106
(928) 714-6401
(928) 714-6408
Mailing address
2187 N VICKEY ST, FLAGSTAFF, AZ 86004-6106
(928) 714-6401
(928) 714-6408
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
10957
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000092216
BLUE CROSS/SHIELD OF MONT
MT
01
—
231772
AHCCCS
AZ
01
—
36928
ARIZONA MEDICAL BOARD
AZ
Enumeration date
07/27/2006
Last updated
03/07/2023
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