Healthcare Provider Details

I. General information

NPI: 1730197351
Provider Name (Legal Business Name): PATRICK MCCLURE BOLT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 CLINCH AVE STE 100
KNOXVILLE TN
37916-2435
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-4861
  • Fax: 865-673-8007
Mailing address:
  • Phone: 865-694-0062
  • Fax: 865-694-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number42025
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: