Individual
AUSTIN D BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 200, FORT WAYNE, IN 46845-1714
(260) 425-6030
(260) 425-6028
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
02006973A
IN
207L00000X
Anesthesiology Physician
04960
KY
207L00000X
Anesthesiology Physician
R4351
KY
Other
Enumeration date
03/27/2017
Last updated
03/23/2023
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