MEDICARE: DR. JOHN A BOLIN MD

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	208600000X	Surgery Physician	010571	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205811643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A BOLIN MD

Provider Business Mailing Address
First Line	:	4630 AMBASSADOR CAFFERY PKWY
Second Line	:	STE 406
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6949
Country	:	US
Telephone Number	:	337-989-8770
Fax Number	:	337-989-8768

Provider Business Practice Location Address
First Line	:	4630 AMBASSADOR CAFFERY PKWY
Second Line	:	STE 406
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6949
Country	:	US
Telephone Number	:	337-989-8770
Fax Number	:	337-989-8768

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. JOHN A BOLIN MD” Practice Location

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