Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tyler Jake Tolman

Individual provider Family Medicine Physician · NPI 1740774439

Tyler Jake Tolman is a Family Practice in Eagle, Idaho. Qualified in 2018, 8 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
8
Licensed in
ID
In the registry since
2018
Specialties on file
2
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Practice location Address checks out

3101 E State St Ste AND2107
Eagle, ID 83616-6232
Phone: (208) 473-3500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence O-1336 (ID)
Family Medicine Physician Taxonomy 207Q00000X · Licence MRO-1739 (ID)

Record details

NPI number1740774439
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 18, 2018
Last updated in NPPESNovember 15, 2021
Certification dateNovember 15, 2021
Mailing address190 E Bannock St, Boise, ID 83712-6241

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Eagle