Organization
PENINSULA SURGICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
M TODD BOLING D.O. (OWNER/PRESIDENT)
(907) 235-3225
Entity
Organization
Contact information
Practice address
203 W PIONEER AVE, SUITE 2, HOMER, AK 99603-7527
(907) 262-6800
(907) 262-9276
Mailing address
35477 KENAI SPUR HWY, SUITE 201, SOLDOTNA, AK 99669-7625
(907) 262-6800
(907) 262-9276
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
3945
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MPG0405
—
AK
Enumeration date
08/05/2006
Last updated
11/13/2012
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