Individual
CRAIG WALLIS TOLLESON
Active
Individual
CRAIG WALLIS TOLLESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
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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