Individual
BRENT BOLYARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1620 W STATE HIGHWAY CC, BRIGHTON, MO 65617-9427
(330) 663-1583
Mailing address
1620 W STATE HIGHWAY CC, BRIGHTON, MO 65617-9427
(330) 663-1583
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
E-4507
AR
2084P0804X
Child & Adolescent Psychiatry Physician
E-4507
AR
2084P0805X
Geriatric Psychiatry Physician
E-4507
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158495001
—
AR
Enumeration date
07/20/2006
Last updated
01/02/2017
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