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General NPI Number Information
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NPI Number | 1093716102
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Entity Type | Individual
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Provider Name | PATRICIA A BOLTZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 1 TIMBER WAY SUITE #203
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City | SPANISH FORT
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State | AL
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Zip | 36527-5682
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Country | US
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Telephone | 251-445-7225
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Fax | 251-445-7226
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Provider Business Mailing Address
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Address Line | 1 TIMBER WAY SUITE #203
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City | SPANISH FORT
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State | AL
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Zip | 36527-5682
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Country | US
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Telephone | 251-445-7225
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Fax | 251-445-7226
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 21886
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License Number State | AL
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