Individual
ALEXANDER RICHARD BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4600 MEMORIAL DR STE W1, BELLEVILLE, IL 62226-5359
(618) 233-3066
(618) 233-3066
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-4846
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036163598
IL
207RC0000X
Cardiovascular Disease Physician
036.163598
IL
208M00000X
Hospitalist Physician
036.163598
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.163598
ILLINOIS MEDICAL LICENSE
IL
01
—
DO-05182
IOWA MEDICAL LICENSE
IA
Enumeration date
06/02/2014
Last updated
02/12/2024
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