Boltax, Jonathan Peter
Boltax, Jonathan Peter is an individual health care provider with primary practice located at 555 E Broadway Ave Ste 220 , Jackson WY 83001-8640. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pulmonary Disease, which is considered as his primary health care specialty. Boltax, Jonathan Peter can be contacted via phone (307) 739-7305.Contact Information
Primary practice address
555 E Broadway Ave Ste 220
Jackson WY 83001-8640
Phone: (307) 739-7305
Fax: (307) 739-4960
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | 9935A | Wyoming |
Profile Details
| NPI number | 1629023692 |
|---|---|
| LBN Legal business name | Boltax, Jonathan Peter |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 24th, 2006 |
| Last updated | Jan 4th, 2024 - about last year |
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 | 1629023692 | NPPES |
| Wyoming | MEDICAID | 121002500 |
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