Healthcare Provider Details

I. General information

NPI: 1073141362
Provider Name (Legal Business Name): JAMES LAWRENCE BOLDUC DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

10031 IANS RIDGE RD
ORLANDO FL
32832-5619
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-5551
  • Fax:
Mailing address:
  • Phone: 786-932-6577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS22508
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS22508
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS22508
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: