# BRENT L BOLIN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1376508093
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 33921 | KY | Yes |

## Other

- **Enumeration date:** 04/18/2006
- **Last updated:** 07/09/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000350677 | ANTHEM / NMA | — |
| 01 | — | 000052154B | HUMANA / NMA | — |
| 01 | — | 012961 | SIHO / NMA | — |
| 01 | — | 1171473 | PASSPORT / NMA | — |
| 01 | — | 1183574 | CHA / NMA | — |
| 01 | — | 2440810000 | PASSPORT ADVANTAGE | — |
| 05 | — | 64012024 | — | KY |
| 01 | — | 9034053002 | CIGNA / NMA | — |