Individual
JASON MORRIS BOLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 UNIVERSITY DR E, COLLEGE STATION, TX 77840-2661
(979) 691-3300
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
(979) 703-6485
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M0668
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174299103
—
TX
05
—
174299106
—
TX
05
—
182843601
—
TX
01
—
8H9043
BC/BS PROVIDER NUMBER
TX
01
—
8X7829
BCBS
TX
01
—
P00663817
MEDICARE RAILROAD
TX
Enumeration date
04/26/2006
Last updated
12/03/2021
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