Individual
DR. MATTHEW BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1503 S MAIN ST, CROSSVILLE, TN 38555-5967
(931) 484-6196
(931) 456-1047
Mailing address
1100 ENGLAND DR, COOKEVILLE, TN 38501-0924
(931) 528-7531
(931) 520-0413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
21614
TN
208D00000X
General Practice Physician
Primary
MD21614
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4129250
BCBS
TN
Enumeration date
06/09/2005
Last updated
03/17/2018
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