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General NPI Number Information
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NPI Number | 1578642963
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Entity Type | Individual
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Provider Name | CLARENCE WINSTON BOLINGER JR. MD
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Gender | Male
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Dates
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Enumeration Date | 11/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 602 HURST ST
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City | CENTER
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State | TX
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Zip | 75935-3414
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Country | US
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Telephone | 800-893-9698
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD SUITE 201
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E5485
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License Number State | TX
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