Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 20157 | AL |
NPI | 1063576130 |
---|---|
Provider Name | Dr. Joel C Bolen |
First Address | Montgomery, AL 36106-3671 |
Second Address | Montgomery, AL 36106-3671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 25/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000036956 | (05) | AL |
51021380 | BLUE CROSS (01) | AL |
51036956 | BCBSAL (01) | AL |
G34364 | (02) | AL |