Individual
MR. EDGAR HOWARD BOLES III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6225 N STATE HIGHWAY 161 STE 200, NORTHSTAR ANESTHESIA PA, IRVING, TX 75038-2241
(214) 687-0001
Mailing address
503 N PEORIA ST, CHICAGO, IL 60642-6543
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041389755
IL
163W00000X
Registered Nurse
28204790A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
209013610
IL
Other
Enumeration date
11/02/2015
Last updated
11/22/2015
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