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General NPI Number Information
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NPI Number | 1285819516
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Entity Type | Organization
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Legal Business Name | J. BLAKE BOLIN, M.D., P.A.
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Dates
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Enumeration Date | 01/06/2008
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Last Update Date | 01/06/2008
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Provider Practice Location Address
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Address Line | 3550 PARKWOOD BLVD STE 405
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City | FRISCO
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State | TX
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Zip | 75034-1903
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Country | US
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Telephone | 469-287-8800
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Fax | 469-287-8801
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Provider Business Mailing Address
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Address Line | 3550 PARKWOOD BLVD STE 405
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City | FRISCO
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State | TX
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Zip | 75034-1903
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Country | US
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Telephone | 469-287-8800
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Fax | 469-287-8801
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Authorized Official
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Title or Position | BILLING REP
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Name | DONNA K WARD
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Credential | CPC
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Telephone | 214-551-5101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K8014
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License Number State | TX
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