Individual
DR. MARK EDWIN BOLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., M.D.
Contact information
Practice address
2116 W FAIDLEY AVE., DEPARTMENT OF RADIATION THERAPY, GRAND ISLAND, NE 68802-9804
(308) 398-5450
(308) 398-5351
Mailing address
2116 W FAIDLEY AVE., DEPARTMENT OF RADIATION THERAPY, GRAND ISLAND, NE 68802-9804
(308) 398-5450
(308) 398-5351
Taxonomy
Speciality
Code
Description
License number
State
2085R0203X
Therapeutic Radiology Physician
Primary
18773
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025024800
—
NE
Enumeration date
10/02/2006
Last updated
07/08/2007
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