Individual
CRISPIN G. BOLISAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
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
05389R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1313491
—
LA
Enumeration date
04/19/2006
Last updated
12/30/2008
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