Gregory Richard Tollefsbol, PA-C

NPI #1487874624 in Desoto, Texas

Provider Information

NPI Number: 1487874624
Entity Type: Individual
Name: Gregory Richard Tollefsbol, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Apr 30, 2007
Last Updated: Nov 5, 2007

Practice Location

Address: 2701 PRINCE GEORGE AVE
Address 2: SUITE 100
City: Desoto
State: Texas
ZIP Code: 75115-2045
Phone: (972) 296-8888

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary
Physician Assistant - Medical — Medical	363AM0700X

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