Individual
JERRY JOE BOLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4112 MONROE RD, CELINA, OH 45828-9250
(614) 580-8563
Mailing address
4112 MONROE RD, CELINA, OH 45828-9250
(614) 580-8563
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35070190B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000014726
ANTHEM BCBS
—
05
—
0307108
—
OH
01
—
060038975
RAILROAD MEDICARE
OH
01
—
060038975
RAILROAD MEDICARE
—
01
—
12723
NATIONWIDE
—
01
—
1330778
CIGNA
—
01
—
2500965
UNITED HEALTHCARE OF OHIO
—
01
—
289254
BLACK LUNG
—
Enumeration date
04/07/2006
Last updated
03/11/2014
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