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General NPI Number Information
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NPI Number | 1790122778
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Entity Type | Organization
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Legal Business Name | EDGAR B BOLTON DO PA
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 1512 SE 10TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1420
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Country | US
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Telephone | 954-445-1754
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Fax | 954-766-8199
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Provider Business Mailing Address
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Address Line | 1512 SE 10TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1420
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Country | US
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Telephone | 954-445-1754
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Fax | 954-766-8199
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDGAR B BOLTON JR.
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Credential | DO
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Telephone | 954-445-1754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | OS 2458
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License Number State | FL
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