Individual
DR. TRAVIS L BOLTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2400 UNSER BLVD SE, RIO RANCHO, NM 87124-4740
(505) 253-1187
(505) 253-1199
Mailing address
5410 MARYLAND WAY STE 300, BRENTWOOD, TN 37027-5339
(615) 371-5778
(615) 290-5294
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD2017-0672
NM
208M00000X
Hospitalist Physician
Primary
MD2017-0672
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064450100
—
FL
Enumeration date
12/09/2005
Last updated
07/21/2022
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