Individual
MR. ANTHONY BRADLEY BOLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2680
(601) 815-4563
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2680
(601) 815-4563
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
044417
GA
2086S0129X
Vascular Surgery Physician
Primary
20979
MS
2086S0129X
Vascular Surgery Physician
MD00022869
WA
2086S0129X
Vascular Surgery Physician
MD29549
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00832917B
—
GA
05
—
009965915
—
AL
01
—
0140040322
CIGNA HMO
TN
05
—
07188733
—
MS
01
—
100033107
PHP TENNCARE
TN
01
—
3153656
BLUECROSS OF TN
TN
01
—
3740047
UNITED HEALTHCARE
TN
05
—
3812941
—
TN
01
—
4078780
AETNA
—
01
—
56812
FIRST HEALTH
—
01
—
62178953301
JOHN DEERE HEALTHCARE
TN
05
—
8490567
—
WA
01
—
P01189946
RAILROAD MEDICARE PTAN
MS
Enumeration date
12/22/2005
Last updated
12/03/2014
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