Provider Demographics
NPI:1871577858
Name:BOLTON, JAMES B (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:B
Last Name:BOLTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5230 E STOP 11 RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6398
Mailing Address - Country:US
Mailing Address - Phone:317-528-8921
Mailing Address - Fax:317-528-6916
Practice Address - Street 1:5230 E STOP 11 RD
Practice Address - Street 2:SUITE 250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6398
Practice Address - Country:US
Practice Address - Phone:317-528-8921
Practice Address - Fax:317-528-6916
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-02-21
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Provider Licenses
StateLicense IDTaxonomies
IN01045283A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200043520AMedicaid
IN185520AMedicare ID - Type Unspecified
G07352Medicare UPIN