Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 18023 | WV |
N | 207XS0106X | Orthopaedic Hand Surgeon | 18023 | WV |
NPI | 1134186836 |
---|---|
Provider Name | Dr. Luis E Bolano |
First Address | Huntington, WV 25702-1236 |
Second Address | Huntington, WV 25702-1236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 22/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0098065000 | (05) | WV |
0915979 | (05) | OH |
E28940 | (02) | WV |