Healthcare Provider Details

I. General information

NPI: 1073650511
Provider Name (Legal Business Name): JEFFREY THOMAS BOLKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HIGHLAND BLVD
BOZEMAN MT
59715-6900
US

IV. Provider business mailing address

PO BOX 84891
SEATTLE WA
98124-6191
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5000
  • Fax:
Mailing address:
  • Phone: 425-407-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60072352
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD67552
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberT4905
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number87866
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: