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
Fax: (307) 739-4960
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629023692 NPPES
Wyoming MEDICAID 121002500

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