Individual
JOE RANDOLPH BOLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1377 E HERNDON AVE, #104, FRESNO, CA 93720-3022
(559) 450-7455
(559) 450-7473
Mailing address
1377 E HERNDON AVE, #104, FRESNO, CA 93720-3022
(559) 450-7455
(559) 450-7473
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
G88027
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
J3436
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
TX
Enumeration date
10/10/2006
Last updated
01/16/2012
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