MEDICARE: CHRISTOPHER SHAWN BOLT 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	207R00000X	Internal Medicine Physician	MD38256	SC
2	390200000X	Student in an Organized Health Care Education/Training Program	39	NY
3	207R00000X	Internal Medicine Physician	ME126304	FL

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	:	1255684221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER SHAWN BOLT M.D.

Provider Business Mailing Address
First Line	:	5800 NW 66TH AVE
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33067-1300
Country	:	US
Telephone Number	:	954-688-6505
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-9416
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:

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

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	04/03/2023

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