Individual
GORDON BOLLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
100 HIGH ST, BUFFALO, NY 14203-1126
(716) 859-5600
Mailing address
425 ESSJAY RD STE 170, WILLIAMSVILLE, NY 14221-8235
(716) 630-1219
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
309573
NY
363LA2200X
Adult Health Nurse Practitioner
309573
NY
Other
Enumeration date
04/27/2020
Last updated
01/21/2021
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