Bolla, John
Bolla, John is an sole proprietor health care provider with primary practice located at 61 Memorial Medical Pkwy Suite 3803, Palm Coast FL 32164-5981. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bolla, John can be contacted via phone (386) 586-1760.Contact Information
Primary practice address
61 Memorial Medical Pkwy Suite 3803
Palm Coast FL 32164-5981
Phone: (386) 586-1760
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ME0069906 | Florida |
Profile Details
| NPI number | 1396723581 |
|---|---|
| LBN Legal business name | Bolla, John |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 6th, 2006 |
| Last updated | Jan 17th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396723581 | NPPES |
| Florida | MEDICAID | 252225000 |
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