Jack Dale Tolliver Jr., M.D.

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

21479 Issued in KY

Practice address

2120 Cave Spring PL
Louisville, KY 40223-1562

Phone

(502) 931-1373

NPI assigned

Mar 1, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456790400000",
    "number": "1891155024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 CAVE SPRING PL",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402231562",
            "telephone_number": "502-931-1373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 CAVE SPRING PL",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402231562",
            "telephone_number": "502-931-1373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLLIVER",
        "first_name": "JACK",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-01",
        "last_updated": "2016-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "KY",
            "license": "21479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENTUCKY BOARD OF MEDICAL LICENSURE",
            "identifier": "21479",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shermaine Tolentino, APRN, PMHNP
• Terica G Toliver, LCSW
• Sarah A Tolle
• David Tollerud, M.D.
• Cedric Tolliver
• Allison Tolnai
• Stephanie Tom
• Colson Tomberlin
• Whitney Michelle Tomblin, COTA/L
• Scott D Tomchek, PHD OTR L

• Legal Medicine in Louisville, KY
• Providers in Louisville, KY by specialty
• Legal Medicine in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.