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General NPI Number Information
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NPI Number | 1215227558
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Entity Type | Individual
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Provider Name | JARED NATHAN ROLLINS BOLTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 601 S FLOYD ST STE 350
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City | LOUISVILLE
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State | KY
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Zip | 40202-1938
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Country | US
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Telephone | 502-629-2030
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Fax | 502-629-2070
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Provider Business Mailing Address
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Address Line | PO BOX 950202
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City | LOUISVILLE
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State | KY
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Zip | 40295-0202
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 48213
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | R2709
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License Number State | KY
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