Organization
CRISPIN G. BOLISAY, MD APMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISPIN G BOLISAY MD (PRESIDENT)
(985) 646-0360
Entity
Organization
Contact information
Practice address
105 MEDICAL CENTER DR, SUITE 304, SLIDELL, LA 70461-5544
(985) 646-0360
(985) 646-0362
Mailing address
105 MEDICAL CENTER DR, SUITE 304, SLIDELL, LA 70461-5544
(985) 646-0360
(985) 646-0362
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1443476
—
LA
Enumeration date
04/19/2006
Last updated
12/30/2008
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