Organization
LARRY T. BOLTON, M.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY T BOLTON M.D. (OWNER)
(256) 574-3623
Entity
Organization
Contact information
Practice address
303 PARKS AVE, SCOTTSBORO, AL 35768-2411
(256) 574-3623
(256) 574-6223
Mailing address
303 PARKS AVE, SCOTTSBORO, AL 35768-2411
(256) 574-3623
(256) 574-6223
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
5951
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000569
—
AL
Enumeration date
09/08/2010
Last updated
09/08/2010
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