Individual
MR. JAMES M. BOLANOS
Active
Individual
MR. JAMES M. BOLANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10002147
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811077332
—
WA
01
—
322540
WVH LNI
WA
01
—
P01428922
RR MEDICARE WVH
WA
Enumeration date
10/17/2006
Last updated
07/14/2015
Update your record
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