Tolliver, Jack Dale

Tolliver, Jack Dale is an sole proprietor health care provider with primary practice located at 2120 Cave Spring Pl , Louisville KY 40223-1562. He recently has only one registered license in Other Service Providers / Legal Medicine, which is considered as his primary health care specialty. Tolliver, Jack Dale can be contacted via phone (502) 931-1373.

Contact Information

Primary practice address
2120 Cave Spring Pl Louisville KY 40223-1562
Phone: (502) 931-1373
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Legal Medicine 173000000X 21479 Kentucky

Profile Details

NPI number 1891155024
LBN Legal business name Tolliver, Jack Dale
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 1st, 2016
Last updated Mar 1st, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891155024 NPPES
Kentucky Other 21479 KENTUCKY BOARD OF MEDICAL LICENSURE

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