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NPI Code Detail

MEDICARE: RAY BOLANDER

MEDICARE:   RAY  BOLANDER
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
1171W00000XContractorA01522KY

General Provider Information

NPI Number : 1053541433
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAY BOLANDER
Provider Business Mailing Address
First Line : PO BOX 5
Second Line :
City : GARRISON
State : KY
Zip : 41141-0005
Country : US
Telephone Number : 606-584-1169
Fax Number : 800-584-1465
Provider Business Practice Location Address
First Line : 436 HOUSTON OAKS DR
Second Line :
City : PARIS
State : KY
Zip : 40361-2704
Country : US
Telephone Number : 606-584-1169
Fax Number : 800-584-1465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2009
Last Update Date : 07/21/2009

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Directions to “ RAY BOLANDER ” Practice Location

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