MEDICARE: JENNIFER E BOLL MD INC

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	208200000X	Plastic Surgery Physician	36586	AZ

General Provider Information

NPI Number	:	1598950727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER E BOLL MD INC

Provider Business Mailing Address
First Line	:	2034 E SOUTHERN AVE STE Y
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7519
Country	:	US
Telephone Number	:	480-833-5200
Fax Number	:	480-833-2967

Provider Business Practice Location Address
First Line	:	2034 E SOUTHERN AVE STE Y
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7519
Country	:	US
Telephone Number	:	480-833-5200
Fax Number	:	480-833-2967

Authorized Official
Title or Position	:	PLASTIC SURGEON
Name	:	DR. JENNIFER ELIZABETH BOLL
Credential	:	M.D.
Telephone Number	:	480-833-5200

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	03/27/2018

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