Individual
DR. PRESTON BOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
309 W CHURCH ST, GREENWOOD, MS 38930-4305
(662) 453-9004
Mailing address
PO BOX 1410, CLINIC ADMINISTRATION, GREENWOOD, MS 38935-1410
(662) 459-7189
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
80105
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00015222
—
MS
01
—
P00391905
MEDICARE RAILROAD
MS
Enumeration date
03/17/2006
Last updated
04/02/2008
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