Individual
DR. SHAFE D. BOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2780 FREDERICA ST, OWENSBORO, KY 42301-5442
(270) 926-4100
(270) 648-4678
Mailing address
2780 FREDERICA ST, OWENSBORO, KY 42301-5442
(270) 926-4100
(270) 648-4678
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
37532
KY
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
37532
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000226231
ANTHEM
KY
01
—
200044474
RAILROAD MEDICARE
KY
05
—
64051998
—
KY
01
—
K005560
TRICARE
KY
Enumeration date
05/27/2005
Last updated
10/14/2024
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