Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | NC |
NPI | 1033157318 |
---|---|
Provider Name | Jason Bolden |
First Address | Charlotte, NC 28211-4849 |
Second Address | Charlotte, NC 28211-4849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
N0038B | (05) | SC |