MEDICARE: DR. JOSEPH E BOLGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	14517R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013914357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH E BOLGER M.D.

Provider Business Mailing Address
First Line	:	101 OFFICE PARK DRIVE
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055
Country	:	US
Telephone Number	:	318-377-7118
Fax Number	:	318-377-7392

Provider Business Practice Location Address
First Line	:	101 OFFICE PARK DRIVE
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055
Country	:	US
Telephone Number	:	318-377-7118
Fax Number	:	318-377-7392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/13/2013

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