Bolton, Joe Randolph

Bolton, Joe Randolph is an sole proprietor health care provider with primary practice located at 1377 E Herndon Ave #104, Fresno CA 93720-3022. He recently has only one registered license in Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), which is considered as his primary health care specialty. Bolton, Joe Randolph can be contacted via phone (559) 450-7455.

Contact Information

Primary practice address
1377 E Herndon Ave #104 Fresno CA 93720-3022
Phone: (559) 450-7455
Fax: (559) 450-7473
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X J3436 Texas
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X G88027 California

Profile Details

NPI number 1518055441
LBN Legal business name Bolton, Joe Randolph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 10th, 2006
Last updated Jan 16th, 2012 - about 13 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518055441 NPPES
Texas MEDICAID PENDING

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