Healthcare Provider Details

I. General information

NPI: 1598950727
Provider Name (Legal Business Name): JENNIFER E BOLL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 E SOUTHERN AVE STE Y
TEMPE AZ
85282-7519
US

IV. Provider business mailing address

2034 E SOUTHERN AVE STE Y
TEMPE AZ
85282-7519
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-5200
  • Fax: 480-833-2967
Mailing address:
  • Phone: 480-833-5200
  • Fax: 480-833-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number36586
License Number StateAZ

VIII. Authorized Official

Name: DR. JENNIFER ELIZABETH BOLL
Title or Position: PLASTIC SURGEON
Credential: M.D.
Phone: 480-833-5200