Healthcare Provider Details

I. General information

NPI: 1942305594
Provider Name (Legal Business Name): THOMAS JEFFERY BOLL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RIDGEWAY DR
BIRMINGHAM AL
35209-5506
US

IV. Provider business mailing address

3800 RIDGEWAY DR
BIRMINGHAM AL
35209-5506
US

V. Phone/Fax

Practice location:
  • Phone: 205-868-2090
  • Fax: 205-868-2406
Mailing address:
  • Phone: 205-868-2090
  • Fax: 205-868-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number386
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: