Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD.013758 | LA |
N | 208600000X | Surgeon | MD.013758 | LA |
Y | 2086X0206X | Surgical Oncologist | MD.013758 | LA |
NPI | 1154389039 |
---|---|
Provider Name | Dr. John S. Bolton |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70121-2429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 12/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1321877 | (05) | LA |
B62602 | (02) |