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General NPI Number Information
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NPI Number | 1154341568
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Entity Type | Individual
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Provider Name | BRENT BOLYARD MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 01/02/2017
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Provider Practice Location Address
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Address Line | 1620 W STATE HIGHWAY CC
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City | BRIGHTON
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State | MO
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Zip | 65617-9427
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Country | US
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Telephone | 330-663-1583
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 W STATE HIGHWAY CC
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City | BRIGHTON
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State | MO
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Zip | 65617-9427
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Country | US
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Telephone | 330-663-1583
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | E-4507
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | E-4507
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | E-4507
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License Number State | AR
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