Healthcare Provider Details

I. General information

NPI: 1538279864
Provider Name (Legal Business Name): PAMELA GRAY BOLAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MEDICAL PARK LN SUITE H
MURPHY NC
28906-6920
US

IV. Provider business mailing address

125 MEDICAL PARK LN SUITE H
MURPHY NC
28906-6920
US

V. Phone/Fax

Practice location:
  • Phone: 828-837-2128
  • Fax: 828-837-6244
Mailing address:
  • Phone: 828-837-2128
  • Fax: 828-837-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24742
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberN2009
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN2009
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8916463
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier1538279864
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerBCBSTX
# 3
Identifier1538279864
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerTRICARE SOUTH
# 4
Identifier201428401
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer
# 5
Identifier8BE069
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerBCBSTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: