Individual
DR. PETER R. BOLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1208 MERRY WATER DR, LUTZ, FL 33548-4807
(813) 477-9979
(888) 688-1659
Mailing address
1208 MERRY WATER DR, LUTZ, FL 33548-4807
(813) 477-9979
(888) 688-1659
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
D80591
MD
2085R0202X
Diagnostic Radiology Physician
MD433914
PA
2085R0202X
Diagnostic Radiology Physician
Primary
ME104023
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009111600
—
FL
01
—
14N46
BLUE CROSS
FL
Enumeration date
03/25/2008
Last updated
09/16/2016
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