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General NPI Number Information
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NPI Number | 1710280219
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Entity Type | Individual
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Provider Name | BRIAN BOLINGER M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 1055 SAXON BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8468
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Country | US
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Telephone | 407-200-2355
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Fax |
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Provider Business Mailing Address
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Address Line | 900 WINDERLEY PL STE 2100
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City | MAITLAND
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State | FL
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Zip | 32751-4191
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Country | US
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Telephone | 407-200-2355
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 57.018347
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 64234
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME150914
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License Number State | FL
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