Individual
CARLA PRINCE BOLIVAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
515 MAPLE VALLEY DR, FARMINGTON, MO 63640-1919
(573) 760-7920
(573) 756-9597
Mailing address
PO BOX 801143, KANSAS CITY, MO 64180-1143
(573) 331-3000
(573) 331-5073
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2009022078
MO
Other
Enumeration date
05/21/2009
Last updated
03/09/2021
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