Individual
DR. JONATHAN PETER BOLTAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 E BROADWAY AVE STE 220, JACKSON, WY 83001-8640
(307) 739-7305
(307) 739-4960
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-7305
(307) 739-4960
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
9935A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121002500
—
WY
Enumeration date
05/24/2006
Last updated
01/04/2024
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