Doctor Name: | MR. ROY HENRY BOLTON |
NPI Number: | 1306805858 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | R.N., OWNER |
License Number: | 0085013 |
Business Practice Address: | 704 W Main St Palestine, TX - 758012608 |
Business Phone Number: | 9037232355 |
Business Fax Number: | 9037231580 |
Mailing Address: | 704 W Main St, PALESTINE |
State: | TX |
Postal Code: | 758012608 |
Phone Number: | 9037232355 |
Fax Number: | 9037231580 |
NPI Enumeration Date: | 03/22/2006 |
NPI Last Update Date: | 03/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | 0085013 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |