Provider Demographics
NPI:1679734099
Name:TOLLESON, JOSHUA SAMPSON (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:SAMPSON
Last Name:TOLLESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1313 CREPE MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7971
Mailing Address - Country:US
Mailing Address - Phone:870-935-1242
Mailing Address - Fax:870-934-0144
Practice Address - Street 1:1005 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4308
Practice Address - Country:US
Practice Address - Phone:870-935-1242
Practice Address - Fax:870-934-0144
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE8250208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery