Individual
ALEX R BOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
301 HIWASSEE COMMUNITY DR., MADISONVILLE, TN 37354
(423) 436-7730
(423) 436-0384
Mailing address
301 HIWASSEE COMMUNITY DR., SUITE 100, MADISONVILLE, TN 37354
(423) 436-7730
(423) 436-0384
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4902
TN
363A00000X
Physician Assistant
Primary
004090
NY
363A00000X
Physician Assistant
MA-001385-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004090
LICENSE
NY
01
—
910248
NCCPA #
—
01
—
MA-001385-L
LICENSE
PA
Enumeration date
12/23/2005
Last updated
03/07/2023
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