Individual
GREG H BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2495 SHREVEPORT HWY, PINEVILLE, LA 71360-4044
(318) 473-0010
Mailing address
4100 EMBASSY DR SE, SUITE 200, GRAND RAPIDS, MI 49546-2416
(616) 975-1845
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.A10512.RX
LA
363AM0700X
Medical Physician Assistant
Primary
A10512
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A10512
STATE LICENSE NUMBER
LA
Enumeration date
08/24/2006
Last updated
07/28/2023
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