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Individual

EDGAR B BOLTON JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1900 N UNIVERSITY DR, SUITE 107, PEMBROKE PINES, FL 33024-3618
(954) 441-1616
(954) 766-8199
Mailing address
1512 SE 10TH ST, FORT LAUDERDALE, FL 33316-1420
(954) 445-1754
(954) 766-8199

Taxonomy

Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
OS2458
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
037708200
FL
01
HF850A
MEDICARE PTAN
FL
Enumeration date
11/08/2005
Last updated
02/11/2016
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