Individual
DAVID DMITRY BOLTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1901 N MACARTHUR BLVD, IRVING, TX 75061-2220
(972) 579-8485
Mailing address
1901 N MACARTHUR BLVD, IRVING, TX 75061-2220
(972) 579-8485
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M8543
TX
208M00000X
Hospitalist Physician
M8543
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200691801
—
TX
01
—
8X0058
BCBS
TX
Enumeration date
05/19/2007
Last updated
04/02/2010
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