Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | MD.200870 | LA |
NPI | 1487864708 |
---|---|
Provider Name | Michael Todd Bolton |
First Address | Baton Rouge, LA 70808-4300 |
Second Address | Baton Rouge, LA 70809-3481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 18/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04953094 | (05) | MS |
1071871 | (05) | LA |