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General NPI Number Information
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NPI Number | 1235179482
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Entity Type | Individual
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Provider Name | JOHN D. BOLDIZAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1333 S DICKINSON DR UNIT 140
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City | LELAND
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State | NC
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Zip | 28451-6434
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Country | US
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Telephone | 910-662-6600
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Fax | 910-550-3787
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Provider Business Mailing Address
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Address Line | PO BOX 936857
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City | ATLANTA
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State | GA
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Zip | 31193-6857
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Country | US
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Telephone | 910-686-2525
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Fax | 910-686-1606
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200300562
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License Number State | NC
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