Individual
BAKER BOLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1690 SKYLYN DR STE 300A, SPARTANBURG, SC 29307-1022
(864) 342-4200
(864) 585-2488
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37179
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371797
—
SC
01
—
SCB0215019
MEDICARE PIN
SC
Enumeration date
06/18/2014
Last updated
12/01/2020
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