Individual
DR. GEROME VALLADOLID BOLALIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1717 S J ST, TACOMA, WA 98405-4933
(253) 426-6341
(253) 398-5687
Mailing address
1717 S J ST, TACOMA, WA 98405-4933
(253) 426-6341
(253) 398-5687
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01074664A
IN
207R00000X
Internal Medicine Physician
Primary
MD60819263
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000976632
ANTHEM (REID PHYSICIAN ASSOCIATES, INC.)
—
05
—
0121786
—
OH
05
—
201305950
—
IN
05
—
2113646
—
WA
Enumeration date
07/09/2012
Last updated
12/01/2020
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