Individual
MR. LESLIE ROY BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1636 REGULUS AVE, VIRGINIA BEACH, VA 23461-2200
(757) 492-2026
Mailing address
1636 REGULUS AVE, VIRGINIA BEACH, VA 23461-2200
(757) 492-2026
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
INDEPENDENT DUTY COR
MILITARY
VA
Enumeration date
07/16/2007
Last updated
07/16/2007
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