MEDICARE: DR. MARY E BOLL AUD

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	237600000X	Audiologist-Hearing Aid Fitter	DA1754	AZ

General Provider Information

NPI Number	:	1487799557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E BOLL AUD

Provider Business Mailing Address
First Line	:	10174 E CANYON MEADOW DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5505
Country	:	US
Telephone Number	:	520-296-2894
Fax Number	:

Provider Business Practice Location Address
First Line	:	6567 E CARONDELET DR STE 515
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-6158
Country	:	US
Telephone Number	:	520-296-8500
Fax Number	:	520-733-2389

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	06/22/2010

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