Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 255586 | MA |
N | 111NI0900X | Internist | 255586 | MA |
N | 207RI0200X | Infectious Disease | 265066 | MA |
Y | 207RI0200X | Infectious Disease | 64452 | MN |
NPI | 1063850543 |
---|---|
Provider Name | Tyler Bold |
First Address | Boston, MA 02115-6110 |
Second Address | Minneapolis, MN 55455-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2013 |
Last Update Date | 18/09/2018 |