MEDICARE: DR. PATRICIA A BOLTZ 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	21886	AL

General Provider Information

NPI Number	:	1093716102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA A BOLTZ M.D.

Provider Business Mailing Address
First Line	:	1 TIMBER WAY
Second Line	:	SUITE #203
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5682
Country	:	US
Telephone Number	:	251-445-7225
Fax Number	:	251-445-7226

Provider Business Practice Location Address
First Line	:	1 TIMBER WAY
Second Line	:	SUITE #203
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5682
Country	:	US
Telephone Number	:	251-445-7225
Fax Number	:	251-445-7226

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/06/2010

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