Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 165008-1205 | UT |
Y | 2080P0204X | Pediatric Emergency Doctor | 165008-1205 | UT |
NPI | 1063454064 |
---|---|
Provider Name | Dr. Robert G Bolte |
First Address | Salt Lake City, UT 84108-1220 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 30/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002085363 | (05) | NV |
003594800 | (05) | ID |
0142664 | (05) | MT |
06395 | (05) | UT |
1172456 | (05) | LA |
121338500 | (05) | WY |
F14628 | (02) | UT |